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CMTH/EXSS ORDER FORM

PURCHASE ORDER REQUEST

February 2009

Steve Cussell signature


(Please request for this form to be signed by Steve Cussell if the order is for the
cleanroom)

Fax number

Carolyn Dale signature

Tel number

Bhavna Patel signature

Suppliers address

Quotation number if applicable.


Date26/11/10...

Name of person placing orderYe Xiao.


Account holder.
Charge to account

Project.
Other

SUPPLIERS
REFERENCE NUMBER.
HP CE250A

DESCRIPTION OF GOODS
Black printer toner cartridge

QTY
1

PRICE
PER ITEM (exc. VAT)

ITEMS FOR
(Please state lab, office or other)
H1101

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