XYZ, Inc.
Name City, State, Zip
PURCHASE ORDER
The following number must appear on all invoices, bills of lading, and acknowledgements relating to this PO: PURCHASE ORDER: TO:
P.O. DATE TERMS F.O.B. SHIP VIA ADDRESS CORRESPONDENCE TO: Name
E-mail Phone FAX # Sales Tax Rate:
QTY UNIT
5.00%
DESCRIPTION UNIT PRICE AMOUNT
2 43 17
Dozen Case Tube
Product Product Product
12.50 0.45 4.50
25.00 19.35 76.50
subtotal PLEASE NOTIFY US IMMEDIATELY IF THIS ORDER CANNOT BE SHIPPED COMPLETE ON OR BEFORE: April 1, 2003 SHIP TO: SHIPPING TAX OTHER TOTAL
120.85 16.00 6.04 $142.89
APPROVED BY
DATE
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