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Online Forms: Back Order Acknowledgement

Back Order Acknowledgment Form

This form may be submitted on line or printed and submitted to the Purchasing Office.

This form is to be used to acknowledge the receipt of back ordered items or partial deliveries. This form is usually used in place of the green copy of the purchase order when the green has previously been forwarded to the Purchasing Office.

INSTRUCTIONS FOR COMPLETION


Please type or print neatly.

  • Enter the vendor name exactly as it appeared on the original purchase order.
  • Enter purchase order number and the date of the purchase order.
  • Enter the budget account number and expense object classification.
  • Enter description of item(s) received using the same description that appeared on the original purchase order or on your purchase requisition.
  • Check if the order is complete or incomplete.
  • Please sign and enter date (this is recorded as the date the items were received).

THIS FORM SHOULD BE RETURNED TO THE PURCHASING OFFICE AS SOON AS ITEMS ARE RECEIVED ALONG WITH ANY INVOICES RECEIVED WITH THE MERCHANDISE.

Form Information
Vendor:
P.O. #:
Date:
Department:
Dept #:
(xx.xx.xxxxxx.xxxxx.xx)

The following back order has been received and is approved for payment:

Order Status:
Authorized by:
E-mail:
Phone:
Date:

Receipt of this form will be verified by e-mail.