Purchase Order Master 09 - Lead

Print Form
LEAD-DEADWOOD SCHOOL DISTRICT #40-1
Phone (605) 717-3890
320 South Main Street • Lead, South Dakota 57754-1548
SALES TAX EXEMPT #1014-4364-RS
Fax (605) 717-2813
Purchase Order Number
P.O. Date
Requisitioned By
Date
Vendor #
Fax #
School Building
Room Number
Administrator's Signature
Date
Ship To:
PURCHASE ORDER # MUST APPEAR ON ALL CORRESPONDENCE
Quantity
Catalog No & Pg.
Itemized description of materials and supplies or
Personal Service and travel information
Unit Price
Multiply
Quantity * Unit
Price
Invoice Total
OFFICE USE ONLY
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THIS COPY MUST BE SIGNED BY VENDOR AND RETURNED WITH
INVOICE BEFORE PAYMENT WILL BE MADE.
NOTE:
I declare and affirm under the penalties of perjury that this claim has
Your Signature on
voucher is requested
TOTAL
Verification of Superintendent or Other Authorized Agent of District
been examined by me, and to the best of my knowledge and belief, is I declare and affirm under the penalties of perjury that this claim has been examined by me, and to the
in all things true and correct.
best of my knowledge and belief, is in all things true and correct. I further certify that the above
services were rendered, or that the above listed materials were received in an acceptable condition,
and that the above claim is hereby approved by me for payment.
Date _______________________________ 20_____
SIGNED _______________________________________________
SIGNATURE OF CLAIMANT
Account Number
this _________________day of ______________________________ 20_____
(Superintendent, Clerk, or Other Authorized Agent)
Amount
It is the desire of the Board of Education that All
purchases be made locally whenever
quality and price of merchandise are competitive.