Jl.

Palem Raya, Desa langenharjo

Grogol Sukoharjo

To : Po No :
Address : Date of Order :
PR No :
Contact Person : Department :
Telepohone/ Fax : Term of Payment :
Email

PURCHASING ORDER
NO DESCRIPTION QTY UNIT PRICE LIST AMOUNT

SUB TOTAL
Terbilang : POTONGAN
PPN 10 %
BIAYA PENGIRIMAN
TOTAL

Note :
1. Semua pengiriman barang harus di sertakan Nota/ Faktur dan kwitansi
2. Baranng akan kami kembalikan apabila tidak sesuai pesanan
3. Nomor PO harus di cantukan dalam Nota/Fatur/ kwitansi
4. Bila pengiriman barang akan di laksanakan secara bertahap
Setiap pengiriman barang harap disertakan photocopy PO

Prepared by Verified by Approved by

Admin Logistik Ka.Bag Logistik Wakil Direktur Direktur Utama

 PURCHASE REQUEST
NO : DATE : 17-Jun-17 DEPARTMENT : PPI
LAST PURCHASE ARTICLE QUATATION
DATE PRICE
SUPPLIER STOCK
ON QTY
QTY UNIT DESCRIPTION SUPPLIER I SUPPLIER II SUPPLIER III TOTAL
UNIT HAND

FAILITAS CUCI TANGAN

DISPENSER HANDSOAP
HANDSOAP
TISSUE
DISPENSER TISSUE
BANNER
TEMPAT SAMPAH INFEKSIUS
TEMPAT SAMPAH NON INFEKSIUS
DLL

Requested by Ka Bag Logistik Wakil Direktur Direktur

Destya Andi, S.kep, Ns Dian Ayu R,S.Farm, Apt dr. Bambang Santoso, M.kes dr. Imelda Tandiyo ,FASE,MM
 STORE ROOM REQUISITION STORE ROOM REQUISITION
DATE : / / 2017 DATE : / / 2017
REQUESTED QTY REQUESTED QTY
CODE DESCRIPTION UNIT UNIT PRICE CODE DESCRIPTION UNIT UNIT PRICE
QTY UNIT ISSUE QTY UNIT ISSUE

Prepared by Approved by Issued by Prepared by Approved by Issued by

Received by Received by