OPEN PURCHASE ORDER

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					                        OPEN PURCHASE ORDER
                      REQUEST FOR DISTRICT FUNDS


DATE:          __        __

PURCHASE ORDER #__                   __

VENDOR: ___               ___
        ___               ___
               ____       ___

AMOUNT: ___              ____

PURPOSE: ___             _____
               ___       _____
               ___       _____

BALANCE REMAINING ON PURCHASE ORDER____                                  __

CHARGE TO:

FUND           LOCATION       OBJECT        FUNCTION       PROJECT        AMOUNT
_    _         __    _        __    _       _    _         _    _         __   _
_    _         __    _        __    _       _    _         _    _         __   _
_    _         __    _        __    _       _    _         _    _         __   _
_    _         __    _        __    _       _    _         _    _         __   _
_    _         __    _        __    _       _    _         _    _         __   _
_    _         __    _        __    _       _    _         _    _         __   _

Receipts must be attached to this form. Please keep a total of all invoices charged
against each purchase order, and enter balance remaining after the attached receipts
are paid. This will be checked with the budget at the District Office to be sure we have
received and paid all invoices. Please submit the receipts for payment as soon as
possible to avoid the chances of losing the receipts. Thank you.


Requested By

Supervisor’s Signature

District Administrator


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