Supplier______________________________________ P.O No.

_____________________________________

Address Date: _____________________________________

  Mode of Procurement: _________________________
  PR No./s: ____________________________

Gentlemen:  

Please furnish this office the following articles subject to the terms and conditions contained herein:

Place of Delivery: _______________________________ Delivery Term: _________________________________

Date of Delivery: _______________________________ Payment Term: _________________________________
   
Ite Quantity Description Unit
m Cost
No.