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Entity Name: DEPED-DIVISION OF SAMAR Fund Cluster: _____________

PURCHASE ORDER
DEPED – DIVISION OF SAMAR
Entity Name

Supplier:______________________________________ P.O. No. : ______________________


Address:______________________________________ Date : _________________________
TIN:__________________________________________ Mode of Procurement: ____________

Gentlemen:
Please furnish this office the following articles subject to the terms and condition contained
herein:
Place of Delivery: _________________________ Delivery Term:
Date of Delivery: _________________________ ___________________
Payment Term: __________________

Stock/Property Unit Description Quantity Unit Cost Amount


No.

(Total Amount in Words)

In case of failure to make the full delivery within the time specified above, a penalty of one-tenth
(1/10) of one percent for every day of delay shall be imposed on the undelivered item/s.
Conforme: Very truly yours,

_________________________________ ____________________
Signature over Printed Name of Supplier School Head
_____________________________
Date

Fund Cluster: ___________________________ ORS/BUR No. : ____________________


Funds Available: ________________________ Date of the ORS/BURS: _____________
Amount: _________________________
_______________________
ADMINISTRATIVE ASSISTANT

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