EXHIBIT D � CERTIFICATION OF GOODS FORM - DOC

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					                         EXHIBIT D – CERTIFICATION OF GOODS FORM

                             CERTIFICATION OF RECEIPT OF GOODS
                            PROCUREMENT CREDIT CARD PROGRAM


I CERTIFY THAT THE FOLLOWING ITEMS WERE ORDERED FROM:

____________________________________ AND RECEIVED ON ______________________
    (Name of Vendor)                                           (Date)


Item No.     Qty                       Description               Unit Price          Extension




                                                                 Subtotal
                                                                 Sales Tax

                                                                 Shipping/Handling

                                                                 TOTAL               $



Reason(s) itemized invoice/receipt was not obtained for this order:

______________________________________________________________________________________
______________________________________________________________________________________
_____________________________________________________

______________________________________________.                ________________
Cardholder Signature                                           Date

______________________________________________                 _________________
Approving Official                                             Date

				
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