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Purchase Request Form

Cambrian aims to process all purchase requests received by Tuesday on Wednesday. If we don’t get to all of them, the ones that have been missed will be the following Wednesday’s priority.

Cambrian FMS will review this document and decide whether the requested item(s) adheres to the confines of the approved Spending Plan, and supports the Participant’s objectives. If it’s decided that further explanation is needed before processing, we’ll reach out.

Please make sure to outline in detail how the item(s) will support the participant’s Self-Determination goals.

Name of Client:
Date of Request:
Service Code that item(s) fall
How does item
support self-
Determination goals:
Email Address:

Thanks! We’ll send you a price quote shortly.

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