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  2.  ______________________________________________________________________________
  3. |                                                                              |
  4. |                                PURCHASE ORDER                                |
  5. |______________________________________________________________________________|
  6. |Page:   | Date:      |    Show this number on   | P.O. Number:                |
  7. |        |            |  Shipment and Billing -> |                             |
  8. |________|____________|__________________________|_____________________________|
  9. |   |                                  |   |                                   |
  10. | V |                                  | S |                                   |
  11. | E |                                  | H |                                   |
  12. | N |                                  | I |                                   |
  13. | D |                                  | P |                                   |
  14. | O |                                  |   |                                   |
  15. | R |                                  | T |                                   |
  16. |   |                                  | O |                                   |
  17. |___|__________________________________|___|___________________________________|
  18. |Requested By:        |Dept.           |Required Date:      |Ship Via:         |
  19. |                     |                |                    |                  |
  20. |_____________________|________________|____________________|__________________|
  21. |         |                                 |               |                  |
  22. | QUANTITY|             DESCRIPTION         |    PRICE      |      AMOUNT      |
  23. |_________|_________________________________|_______________|__________________|
  24. |         |                                 |               |                  |
  25. |         |                                 |               |                  |
  26. |         |                                 |               |                  |
  27. |         |                                 |               |                  |
  28. |         |                                 |               |                  |
  29. |         |                                 |               |                  |
  30. |         |                                 |               |                  |
  31. |         |                                 |               |                  |
  32. |         |                                 |               |                  |
  33. |         |                                 |               |                  |
  34. |         |                                 |               |                  |
  35. |         |                                 |               |                  |
  36. |         |                                 |               |                  |
  37. |_________|_________________________________|_______________|__________________|
  38. | Special Instructions:                     |     TOTAL:                       |
  39. |                                           |__________________________________|
  40. |                                           | Approval:                        |
  41. |                                           |__________________________________|
  42. |                                           | Date:                            |
  43. |___________________________________________|__________________________________|
  44. |                                                                              |
  45. |         NO CHANGES OR DEVIATION OF THIS PURCHASE ORDER WILL BE VALID         |
  46. |                    UNLESS AUTHORIZED BY WRITTEN AMENDMENT                    |
  47. |                                                                              |
  48. |               WE RESERVE THE RIGHT TO CANCEL IN CASE OF DELAY.               |
  49. |______________________________________________________________________________|
  50.