Report New Inventory Item Purchase(s)
Please use this form to document and report the purchase of new inventory for your Center including:

• All items with a unit cost (including ancillary costs) of $5000  or more
• Small and attractive items with unit costs of $300 or more; including but not limited to: computer equipment, laptops/notebook computers, tablets/smart phones, office equipment, communications and A/V equipment, CD/record players, radios, TVs, DVD players, cameras, television sets, DVD players, video cameras, and photographic projection equipment.
• Appliances with unit costs of $300 or more
• Curricula  in hard copies purchased by DCYF for Center
• Other items identified by your Center as vulnerable to loss

Refer to Center Inventory Procedure as needed for specific guidance.
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Center Name: *
Staff Name: *
Preferred Contact Info: *
Which category does this inventory item fall under? *
What is the funding source for this item (mark all that apply)? *
Required
For every funding source selected, please indicate the cost allocation %? *
Example: ECEAP 100% or ECEAP 40%, HS 60%
Purchase date: *
MM
/
DD
/
YYYY
Order number: *
This is typically found on receipt or purchase document.
Description of item: *
Name of the item.  Examples: Projector Screen, TV, Speakers, Tablet
Manufacturer name: *
Quantity purchased: *
Inventory control number (tag): *
An inventory control number uniquely identifies the product you purchased. Centers develop their own inventory control number and can inscribe on or attach tag to item. Purchased 1+ items? Make sure to include an IC number for each item, separated by a comma.
Serial number: *
Serial numbers are usually printed on stickers or etched into some devices, but if the sticker is removed or worn then you will need to find the number on your device.  Purchased 1+ items? Make sure to include the serial number for each item (w/ inventory control #), separated by a comma.
Condition of item: *
Location of item: *
Which Site is the item kept/utilized at? Purchased 1+ items? Make sure to include the location for each item (w/ inventory control #), separated by a comma.
Unit cost *
Total cost of (1) item.
Total cost or value at time of purchase (including all ancillary costs) *
Purchase just one? This should be same as unit cost. Purchased 1+? Total cost for all items.
Anticipated useful life, in years: *
See Center Inventory Procedure if needed for guidance.
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