FULRUBELL CORPORTAION

PURCHASE REQUISITION FORM

Requisitioner Info: Recommended Vendor Info:
Request Date : January 4, 2019 Name: POLARIS POWER ENGINEERING
Name ULYSSES A. DELANTE Address: 100 SILIMAN AVENUE, 6200 DUMAGU
Department PSS VISAYAS AREA (DUMAGUETE)
Purpose CORRECTIVES FOR VISAYAS
Contact Nos.: 225-4745/422-6871
Fax No., if any:
Email address:
Date Needed AS SOON AS POSSIBLE Contact Person:

ITEM NO. QUANTITY DESCRIPTION

1 1 GE CIRCUIT BREAKER 100A, 3P, TQD

Special Instructions:
ASAP!

Requested by: Noted by: Approved by:

DELANTE, ULYSSES A. JJ, AGCAOILI PEREZ, ROMM

Initial/Signature/Date Initial/Signature/Date Initial/Signature/D

Checked by:

FERRER, MELVIE JANE

RM
d Vendor Info:
POLARIS POWER ENGINEERING
100 SILIMAN AVENUE, 6200 DUMAGUETE CITY

225-4745/422-6871

ISSUED
PRICE RECEIVED/ DATE
QTY.
6,671.00

Approved by:

PEREZ, ROMMEL
Initial/Signature/Date
 FULRUBELL CORPORATION

REQUEST FOR PAYMENT FORM

Requesting Payment for: Control No:

Payee's Name: POLARIS POWER ENGINEERING

Site/Location: 100 SILIMAN AVENUE, 6200 DUMAGUETE CITY
Particulars:
GE CIRCUIT BREAKER 100A, 3P, TQD
(WORK ORDER NO. 19-000037)

PAYMENT INSTRUCTIONS
Amount Requested: Php ₱ 6,671.00 Date of Request:

CASH/ATM

CHECK PAYABLE TO

x FOR DEPOSIT TO BANK/BRANCH METROBANK

ACCOUNT NO. 443-3-44309401-7
REMIT THRU: ________________________

X FOR LIQUIDATION FOR REIMBURSEMENT

Remarks:

ASAP

Requested by: Noted by:

DELANTE, ULYSSES A. AGCAOILI, JJ

Name/Signature/Date Initial/Signature/Date

Checked by:

FERRER, MELVIE JANE

Control No: VISAYAS-C7-0119-006

TE CITY

Date of Request: 1/4/2019

BANK
309401-7

FOR REIMBURSEMENT

Approved by:

PEREZ, ROMMEL
Initial/Signature/Date