Sam Rayburn Independent School District
		Requisition for Purchase Order
Vendor Name:
Vendor Address:
Vendor Phone / Fax:
Customer Name:
Ship to (School):
Shipping Address:
Keyorg/Acct#:
Bill to:		Sam Rayburn ISD
Billing Address:		9363 E FM 273, Ivanhoe, TX 75447
	S & H (if %) :
S & H (if flat charge):
Quantity	Stock Number	Description of Item	Unit Price	Total
		Total
		Shipping & Handling (if %)
		Shipping & Handling (if flat charge)
		Total + Shipping & Handling
		Minus Discount (Optional)
Requested By		This is only a request.  Orders cannot be placed until an approved purchase order is issued from the Superintendent's Office.		Approved By
	_______________________		___________________________