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FCPA-Requisition-for-Purchase-Order

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FCPA-Requisition-for-Purchase-Order

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									FLORIDA CLINICAL PRACTICE ASSOCIATION, INC. REQUISITION FOR PURCHASE ORDER
FCPA ACCOUNT #: VENDOR: QUOTE #:

ITEM

DESCRIPTION

QTY

PRICE

TOTAL

GRAND TOTAL

$

-

SHIP TO: DEPT CONTACTS:

BILL TO:

INCLUDE NAME & PHONE NUMBER FOR EACH CONTACT

AUTHORIZATION

11/27/2009 DATE


								
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