419-755-4734
Software Purchase Request Form
Date Click here to enter text.
1. Department Information
Requestor Department Phone
Software Administrator Phone Email
Technical Support Phone Email
2. Budget Information
Account Name/Number Total Software Purchase Amt.
Software will be: A One-time Purchase Number of Licenses/seats License Price (ea)
Requires Annual Maintenance Annual Maintenance Cost _
Will there be additional implementation costs involved? No Yes (if yes please describe below and include additional costs)
3. Software Information
Name of Software Company Name
(Include complete name and version)
Software Website
Software Description
(Describe the purpose of the software and how it will be used at the College. Include departments that will be using the software).
419-755-4734
4. Software Company/Vendor or Publisher Information
Vendor Name Sales Representative Name
Sales Representative Phone Email
Vendor Technical Support (list name and phone number)
5. Software Delivery
(check method software is to be delivered and provide more details such as building, room number, total PC’s, classroom name, or names of individual PC
owner in the box below)
College Hosted Server Vendor Hosted Server Campus Wide PC’s Computer Lab
Departmental PC Classroom PC Individual PC’s
419-755-4734
6. Software Life Expectancy
< 1 year 1-3 years >3 years
7. Technical Requirements
Please provide details of technical requirements of the computer or laptop for software installation or type “see attached” and attach
printed specs.
8. Approvals
The department Dean/Supervisor understands their department is financially responsible for all licenses, upgrades, and or maintenance
throughout the life time of the software use. A copy of all licenses and installation keys must be provided to the IT department each year
that the software is renewed.
Department Dean/Supervisor Date NCSC IT Director Date
9. Software Purchase Information
Software Purchased From Vendor PO # Date
License Key
419-755-4734
1. Department Contact Information
Specify a name, email address, and telephone number for both an administrative employee and an individual who is
technically responsible for the Software within the Department.
2. Budget
Indicate the account number from which funds will be used to purchase this Software. Specify the purchase price of the Software
and any annual maintenance costs. Also, estimate any additional implementation costs including labor, hardware, training,
etc. Then, if necessary, indicate the account number from which funds will be used to purchase a server to support this
Software. Specify the purchase price of the hardware and any annual maintenance costs. Also, estimate any additional
implementation costs associated with the server including labor, hardware, training, etc.
3. Software Information
Specify the complete name of the Software. Include the company name and version number and website. Example: Microsoft
Office 2013. Describe the purpose of the software and how it will be used at the College. Include departments that will be using the
software.
4. Vendor Contact Information
Specify the name of the vendor from which the Software will be purchased. Provide a name, email address, and telephone
number for both a sales person and an individual who can answer technical questions about the Software.
5. Software Delivery
Indicate how the Software will be delivered and provide more details such as building, room number, total PC’s, classroom
name, and or names of individual PC’s the software will be installed on in the provided box.
6. Expected Life Expectancy
Check the box that indicates the number of years that this Software will be used. For example, maintenance costs may
cover minor upgrades but eventually a major upgrade or new release of the software will need to be purchased; or the
Software may be a temporary solution associated with a time-limited College program.
7. Technical Requirements
Specify the minimum hardware configuration necessary to operate the Software. You may also note “see attached”
in the box and attach printed specs from the Software company.
8. Approvals
The appropriate signatures affixed to this form indicate approval for the purchase of the Software.
Department Dean/Supervisor. Obtain the signature of an employee authorized to sign for the Budget
Account Number. Also, indicate the date that the Software will be purchased.
ITS. Obtain the signature of the IT Director.
9. Software Purchase Information
After Software purchase, provide which vendor the software was purchased from, the purchase order number, date purchased and the
licenses key. A copy of all documentation pertaining to the purchased Software including Software certificates must be forwarded to
the IT department.
