${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 |