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District Equipment Purchase Request

"*" indicates required fields

Name*

First Last

Email*

Item Requested*

When Applicable Include: Manufacturer, Model, Size, & Part Number

Vendor

QTY:*

Purpose*

Asset Location*

Would the item be purchased on State Bid?*

No

Yes

Unknown

Can a similar product be substituted?*

Yes

No

Why can't a similar product be substituted?*

Compatibility - Needs to connect with existing hardware/software

Continuity - Matches existing in service item

Quality - Considered best built product for the job

Other (Describe Below)

Other Reason for No Substitutes*

Cost

Has the requester obtained any quote(s)?*

Online Pricing, Verbal Quote, or Written Quote

Yes

No

Quote #1*

Please enter a number from 0.01 to 999999.99.

Source of Quote #1:*

Quote #2

Please enter a number from 0.01 to 19999.99.

Source of Quote #2:

Quote #3

Please enter a number from 0.01 to 19999.99.

Source of Quote #3:

Attach Any Supplemental Documentation

i.e. Written Quotes, Manufacturer/Vendor Docs

Drop files here or

Max. file size: 200 MB.

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Westhampton Beach Fire Department

92 Sunset Ave.
Westhampton Beach, New York 11978

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Emergency: 911
Non-Emergency: 631-288-1255

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