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NOTE: Correct procedure is to acquire a

purchase order (if vendor will accept a purchase

order) before ordering merchandise/services.

If you have questions, see Tara Dabe/stein.

Dover-Eyota Schools Purchase Order/Check Request

ACTIVITY FUNDS

Activity Account Name ______________ _ Activity Account Number _____ _

Please issue a: ---Purchase Order (Have you checked to see if supplier will accept a purchase order?)

___ Check (Request check only if vendor will not accept purchase order or if you are seeking

reimbursement for items/services you paid for. Checks written on Friday after Noon.)

Vendor/Supplier: Ship To:

Name Your Name

Street Address School Building

City, State, Zip

Fax# (if available) Today's Date Date Check or P.O. Required

F p or urc h ase 0 d C r er omp I t e e Th' IS S f ec IOD. If ordering from verbal quote, obtain a written quote and attach.

Stock# Quantity Description Unit Price Extended Amt

MORE LINES AVAILABLE ON REVERSE SIDE OF THIS SHEET. (If you are using online form, you'll need to start a new form)

Turn in signed packing slip (if any) when items received. Total P.O. Amt

F or Ch ec kC omp I t e e Th" IS S f ec IOD. Attach copies of invoices, receipts, tournament sign up fonns, etc.

List each item separately (ex: reimbursement for. .. , registration fee, etc.) AMOUNT

Check Total

Signature of person making request Principal/Supervisor Signature

Student signature John Ostrowski, if applicable (any Activity sport accounts)