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CAPITAL PURCHASE REQUISIT'lel.N 
...... ~·­
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Date: 5/28/19 Com an: Deliver To: if different from above 
Contract  D  Yes  D  No  
Se,vfce Contract  ¸  · Contract# -:":'=-----­Yes D No  
Service Contract#  _  
D  Facllllles  


Cost Center: 46801  
Re uired Date: 7/1/19  mm/dd/ r  


lnslallation Cost 
D 
Labor Cost 
D 
Materials Cost 
D 
Total Above Cost 
D 
Installation & Testing Time 
D 
Removal Cost Replaced Item Budgeted Allowance Savings 
CareFusion 
Trade-in Information 
Customer: Quotation Number: 2019-71798 
The_trade-in total on the quotation page is based on trading In the following products and quantities of product. Unless otherwise agreed In writing, this trade-in commitment Is valid only when executed with the full proposal outlined above. Trade-in units will be picked-up when installation of the proposed equipment is complete or mutually agreeable time. 
,
., ·,: Manutact:urer,~'"-t·'.cfG~-nt:itv· .. A.mount_ per u_nit · -e;t:~ndect tr~d~d~ 
. ' ._.,.;; .. .'fo ~mou,,~i .. }}j 
. 1 1 $5,000.00 I , 1111 
·~-----·-· --· l--·---------·-····­
