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Serving the Community
PURCHASE REQUEST
IMCA PURCHASE REQUEST
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General Information
Department / Program Name
IMCA Entity / Department:
- Select your IMCA Entity / Department -
IMCA (General Operations)
Masjid Al-Fajr
MTI School of Knowledge
IMCA Weekend Academy
Early Education (Daycare)
Food Pantry
Crescent Clinic
Converts Council
Youth Council
Resource Center
Development Department
Finance & Accounting Department
IT Department
Programs Department
Media & Marketing Department
Women Council
Muslim Business Council (MBC)
Muslim Professional Council (MPC)
MSA Council
Other
Other
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Requesting Party
First Name
Last Name
Title / Role:
Email
Phone/Mobile
Department Head / Council Chair
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Purchase Details
Type of Purchase
Goods
Services
Equipment
Maintenance / Repair
Professional Services
Technology / Software
Marketing / Media
Other
Detailed Description of Item(s) or Service(s):
Purpose / Justification
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Cost & Budget Information
Estimated Total Cost:
Budget Line / Account Code
Fiscal Year
Is this included in the approved budget?
Yes
No (Explanation required)
Explanation
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Vendor Information
Preferred Vendor Name
Vendor Phone/Mobile
Vendor Email
Reason for Vendor Selection
Lowest cost
Best value / quality
Prior approved vendor
Program-specific requirement
Sole-source (Justification required below)
Sole-Source Justification
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Quotes & Documentation
Number of Quotes Attached
1 (≤ $500)
2 ($501 – $2,500)
3 or more ($2,501+)
Proposal / Contract
Choose File
W-9 (if new vendor)
Choose File
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Timeline & Urgency
Requested Delivery / Start Date
Is this an emergency purchase?
No
Yes (Executive Director approval required)
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Certifications & Acknowledgment
I certify that:
This purchase is necessary and aligned with IMCA’s mission
Funds are not being split to bypass approval thresholds
I have disclosed any conflict of interest
No commitment will be made without approval
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Submit Request
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