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ACCOUNT NUMBER:
Date

VENDOR
CONTACT NAME
DEPARTMENT
PHONE NUMBER

Ship
To:
University of Wisconsin-Eau Claire
105 Garfield Avenue
Eau Claire, WI 54701

PRICE SOURCE: IF PREPAYMENT IS REQUIRED BY THE VENDOR. A COPY OF THE CATALOG, E-MAIL, OR
QUOTE FROM THE COMPANY INDICATING PREPAYMENT REQUIRED AND THE TOTAL AMOUNT DUE PLUS
SHIPPING/HANDLING MUST BE ATTACHED.



Quantity

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Item Description

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Total
Unit Price

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Total

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VENDOR
PLEASE NOTE: PLEASE PROVIDE EMPLOYER IDENTIFICATION NUMBER
                  AND PURCHASE ORDER NUMBER ON INVOICE.
Deliver between 8 A.M. and 3 P.M.
No Saturday, Sunday, or Holiday deliveries

Show purchase order number on your invoice and
submit invoice in DUPLICATE.

Acknowledge this order promptly.

Accompany each delivery with a shipping ticket or memo
showing Purchase Order Number and material furnished.







Tax Exemptions
The State of Wisconsin and its agencies are exempt
from payment of all federal, state, and local taxes.
(Wisconsin State & Use Tax Exempt # - ES 40706)



APPROVED BY:    _______________________________

ACCOUNT RESPONSIBLE PERSON




   Vendor    Accounts Payable    Department