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Document Number: DVR-14918-E
Description: This form is used to request, review and document approval of purchases of goods and services that exceed the fee schedule prices or scope of services, established policy and/or procedure.
Comments: Form is protected from modification and enabled for form fill (includes tabbed fields for form completion). The print (pdf) version is available for viewing and printing only.
Content Contact: DVR Forms
DVR-14918-E (Electronic Version - Word/29 KB)
DVR-14918 (Print Version - pdf/82 KB)
Note: If you need this form in an alternate format, please send a message to the Content Contact listed above.