Laserfiche WebLink
<br />I <br /> <br />. <br /> <br />TOWN OF ATHERTON <br />1.l)n~II.&IJ13 RE81J11IITI._ <br /> <br />VENDOR: <br /> <br />(/t:J IJ r t ft/ Nod (:/-Iv <br />Name. ~ J <br /> <br />10/7 /I); viii;;;:/;( j7&'7~ <br />Address <br /> <br />DELIVER TO: <br /> <br />. JaN/i. ~ ~?5?z <br />Name <br />hl1~/ _ . <br />Department <br />IffdNf}Jq {; fJ ~ t!IJ 71o(} 111t,c;~fml oe fOlkl,' ItA~ <br />... ~,.I'o/~'I~~~.~~..~!.e...,.._,.. .w.....~.,...:,........ ............... . ~ . Y"'w . .... ...,-..... Ad~~. .~~. ~~tate. ZiP'. . ~ . . : my <br />............ "<"c;-rui~"_'DO' "do; U . r.: . . . _ v V <br />~~~~~~~~~'.n~~.~~..... _.' .:~: ~. ,~ ':" .... '. ..' . <br />'~"';_cO-'~~'" ~E.Y.~tri 'l<< . . <br />~lti~~M:::~~~~~~~~~:.': .:...... .' ...~~. . .' . <br /> <br /> <br />FEDERAL 10 # <br /> <br />s. s. # and OWner's Name <br /> <br />Account # <br /> <br />Qty <br /> <br />Unit <br />Price Description (Part I Model #) . <br /> <br />Total Cost <br /> <br /> <br /> <br /> <br />Req.Delivery Date: <br /> <br /> <br />'A~ !o <br /> <br />Sub- Total <br /> <br />Purchase Order Number Tax <br /> <br />Payment Terms ff) ffJ ~~ . Shipping Cost <br /> <br />R~UIRED CHECKL 1ST: / Total Cost d. <br />within Budget? ~. { If no, then attach explanat~on} <br />Y I ( initials <br />Bids Attached? ( If no. ~hen attach explanation) <br />Y/N initials C;o~ S~ . <br /> <br />Name of Requestor: <br /> <br />. (iU;~ f/o <br />(Print) . <br /> <br /> <br />Dept Mgr. <br />Aproval: <br /> <br />~~ <br /> <br />. (Signature) <br /> <br />RETURN FORM TO FINANCE WlTH BIDDER'S INFORMATlON LIST ATTACHED <br />