Purchase Order

Step 1 of 13

User Email*
What is the purchase order number and date on which the purchase will be made?
Order number:
Purchase date:

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Who is placing the order?
Purchaser Name:
Address
Address: City State / Province / Region ZIP / Postal Code
Phone number:
Email

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Who is the Vendor?
Vendor Company Name:
Address
Address: City State / Province / Region ZIP / Postal Code
Phone number:
Email
Website

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How many unique items are being purchased from the Vendor?
Number of unique items:

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What is the first item you would like to add to this purchase order?
What is the item (or service)?:
What is the quantity ordered?:
What is the price ($) per unit for this item?:
What is the item ID number (if available)?:

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What is the second item you would like to add to this purchase order?
What is the item (or service)?:
What is the quantity ordered?:
What is the price ($) per unit for this item?:
What is the item ID number (if available)?:

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Please provide the following information for the third item being purchased.
What is the item (or service)?:
What is the quantity ordered?:
What is the price ($) per unit for this item?:
What is the item ID number (if available)?:

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Please provide the following information for the fourth item being purchased.
What is the item (or service)?:
What is the quantity ordered?:
What is the price ($) per unit for this item?:
What is the item ID number (if available)?:

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Please provide the following information for the fifth item being purchased.
What is the item (or service)?:
What is the quantity ordered?:
What is the price ($) per unit for this item?:
What is the item ID number (if available)?:

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What is the tax rate that will apply to this transaction?
Tax rate (%):
Total tax ($):

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How will the order be shipped?
Shipping service (e.g. USPS, Fedex):
Shipping method (e.g. overnight delivery, 2-day shipping):
Expected delivery date:
Shipping charge ($):

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Is there going to be a discount given for this transaction?
Discount?:
- Yes
- No
Discount rate (%):
Discount ($):

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Where will the order be delivered?
Company name:
Recipient name:
Address
Address: City State / Province / Region ZIP / Postal Code

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${input_25_6} ${input_25_7_2}, ${input_25_7_3},${input_25_7_4},${input_25_7_5} Phone :		PURCHASE ORDER
		P.O. # ${input_25_3} ORDER DATE: ${input_25_4}
VENDOR	${input_25_12}, ${input_25_13_2}, ${input_25_13_3},${input_25_13_4},${input_25_13_5} Phone :	SHIP TO	${input_25_67} ${input_25_68} ${input_25_69_2} ${input_25_69_3},${input_25_69_4},${input_25_69_5}

SHIPPING SERVICE	SHIPPING METHOD	DELIVERY DATE
${input_25_56}	${input_25_57}	${input_25_58}

Quantity	Item #	Description	Unit Price	Line Total
${input_25_22}	${input_25_23}	${input_25_24}	${input_25_25}	$0.00

Subtotal	$0.00
Sales Tax	${input_25_53}
Shipping Charge	${input_25_59}
Order Total	$0.00

__________________________________

Vendor Signature

__________________________________

Customer Signature

Purchase Order

Step 1 of 13

What is the purchase order number and date on which the purchase will be made?

Who is placing the order?

Who is the Vendor?

How many unique items are being purchased from the Vendor?

What is the first item you would like to add to this purchase order?

What is the second item you would like to add to this purchase order?

Please provide the following information for the third item being purchased.

Please provide the following information for the fourth item being purchased.

Please provide the following information for the fifth item being purchased.

What is the tax rate that will apply to this transaction?

How will the order be shipped?

Is there going to be a discount given for this transaction?

Where will the order be delivered?

PURCHASE ORDER

VENDOR

SHIP TO