Jan uq vo p LINO oi.4ames 04V/ /00 IVO M. Approval/Purchase Items/Payment Request Form Date of R uest: Status: Inventory: Other: Item/Items Requested: e—A-rs TOSS , ( sr- Purchase Price: / js-, — Tax: Shipping: CO're„_C-iN,4 110V. '-- Other: :— Total Expected Cost: 4 5 p c4-( Deposit Required? No: Payment Method: House Account: c_____F_redit Card: List Dept: . Purpose/Description: --r; d e_ 1 A„ s IQ° Rid / 14-#4-"> Company Name: Purchased From , lC Web Site: r» . --ar-1 Reauested By: ri) 6.5-4"/YS o Time Frame for Purchase/Repair: PP ' 04 cfrq 4 — Special Instructions: Attach Ouote: S 4 /PP) Check: (Yes.„„) Competitive Quotes Obtained? Yes: If No, Why Not: Authorization: No: -b0•e-,0; i( ovs-r- o l ci " drA LA) l' e," -4- ee £.-)11/ r-1 ;ek--) C4,6 Ass EFTA00591331