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Purchase Order: (Entity Name) LE Logo Supplier Account #

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[Entity Name]

LE Logo PURCHASE ORDER


The LOGO
Supplier account # needs to go to
the left of the
[Street Address] page no ENTITY DATE 12/12/2020
[City, ST ZIP] NAME JUST PO # [123456]
Phone: (000) 000-0000 LOGO
Fax: (000) 000-0000
Website:

VENDOR SHIP TO
[Company Name] Attention to [Name]
[Contact or Department] [Company Name]
[Street Address] [Street Address]
[City, ST ZIP] [City, ST ZIP]
Phone: (000) 000-0000 [Phone]
Fax: (000) 000-0000

REQUISITIONER SHIP VIA F.O.B. SHIPPING TERMS


Requester Shipping Method FOB Freight Terms

ITEM #/Service DESCRIPTION QTY UNIT PRICE TOTAL


1234 Product XYZ 15 100.00 1,500.00
1234 Product ABC 1 75.00 75.00
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[42]
SUBTOTAL 1,575.00
Comments or Special Instructions TAX -
Please send invoices to ap@puretechhealth.com directly ( I will ask Sathish Also) Hardcode SHIPPING -
OTHER -
TOTAL $ 1,575.00

Yes that is
correct

If you have any questions about this purchase order, please contact
procurement@puretechhealth.com

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