FUNDED PURCHASE ORDER

Name of Governmental Entity *
Address 1
Address 2
City
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Zip Code
Ordering Officer's Name *
Telephone Number *
EMail *
TeleFax Number
Purchase Order Number
Purchase Order Date
Account Number
Finance Number
Name of Entity to receive Invoice
Address 1
Address 2
City
State	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas U.S. Virgin Islands Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip Code
Telephone Number
Fax Number
EMail
Ordered Item: Price Evaluation Training (Minimum of 3 each) - $1,200.00
Additional Quantities @ $400.00 =
Special Instructions/Inquiry