Jail LC Vt.) V1.4VG LILLIe OI.UarI b LLt-• 1340//be1108 p.1 Date of Request: Status: ft,. Approval/Purchase Items/Pavment Request Form Ink 8 Item/Items Requested: 57 vakias , Purchase Price: ->-1 70.3 5 Tax: Shipping: Le 23. Other: St ip: 'b Total Expected Cost 4(0 444 q • Deposit Required? Yes: No; Payment Method: House Account: Credit Card: y 1List -Le c. e Inventory: '65 3 z 0. 'Or 5o. Other: K' Purpose/Description: Coa- t Cfio x Purchased From Company Name: coosK q - Coo-4- Web Site: . Requested By: Time Frame for Purchase/Repair: 4-oAP Special Instructions: Attach Ouote: Yes: 3/ Competitive Quotes Obtained? Yes: 17 If No, Why Not: Authorization: Check 1 4 Oka-) IcL2d\ LA) oc)ci 5C1/4 of No: No: EFTA00591340