Purchase Order Request Form

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Purchase Order Request Form
Req. No. ________________________
Purchase Order No. ________________________
Account No. ______________________
Account Name ____________________________
Professor’s Name ______________________
Signature __________________________________
Your Name ______________________ Your Email __________________________ Your Phone Number ______________
Date __________________
Special Instructions:
Item
Description
Quantity
Unit
Per-Unit
Line Item Total
No.
Price
Price
(each, pkg, case)
In Stock
Lead Time __________________
Total Price ____________
Shipping Preference
Ground
Express
Name of Contact: ______________________
Complete Name of Vendor: ________________________________
Contact’s phone number: ________________
Address of Vendor:________________________________________
Contact’s fax number: __________________
________________________________________
Please attach any web printout or email or faxed quotation received from vendor.
Purchase Order Request Form
Req. No. ________________________
Purchase Order No. ________________________
Account No. ______________________
Account Name ____________________________
Professor’s Name ______________________
Signature __________________________________
Your Name ______________________ Your Email __________________________ Your Phone Number ______________
Date __________________
Special Instructions:
Item
Description
Quantity
Unit
Per-Unit
Line Item Total
No.
Price
Price
(each, pkg, case)
In Stock
Lead Time __________________
Total Price ____________
Shipping Preference
Ground
Express
Name of Contact: ______________________
Complete Name of Vendor: ________________________________
Contact’s phone number: ________________
Address of Vendor:________________________________________
Contact’s fax number: __________________
________________________________________
Please attach any web printout or email or faxed quotation received from vendor.

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