Purchase Order Request Form
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Centralia R-VI School District
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Purchase Order Request Form
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Vendor Name & Address:Person Requesting Purchase:
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Ship To Address: (circle the correct School Location)
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CHSCESBus
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CBMSTechBoard
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Phone Number:
CISChampMaint.
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Fax Number:
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Item NumberDescriptionQty. OrderUnit CodeUnit PriceAmountDiscount Total
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$0.00$0.00
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$0.00$0.00
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$0.00$0.00
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$0.00$0.00
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$0.00$0.00
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$0.00$0.00
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$0.00$0.00
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$0.00$0.00
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$0.00$0.00
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Comments: (Internal Notes)
Subtotal$0.00
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Shipping Cost
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Miscellaneous
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Discount (10%)
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Principal's Approval:
Club or Account Code:Balance Due$0.00
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