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PAYMENT REQUEST FORM

Date June 14, 2023

Acctg. PRF Ctrl No.


PAYABLE TO QUICK AND FAST LOGISTIC SERVICES

PAYMENT Currency ______ Amount 77,274.40 PAYMENT MODE Check Remittance / TT

PAYMENT TERMS DATE NEEDED 06-Jun-23

BANK NAME/BRANCH/ACCOUNT NO.

PURPOSE & CHARGING DETAILS

1. NEGROS ISLAND . DELIVERY DATE 06-JUNE @ 5562.80 liters


2. BOHOL ISLAND TRANSFER DATE 06-JUNE @ 4962.80 liters
3. STOCK TRANSFER CEB-CDO DELIVERY DATE 10-JUNE @ 60 liters
4. STOCK TRANSFER CEB-DVO DELIVERY DATE 10-JUNE @ 200 liters
With Budget Without Budget
total cost per liter 7.16
(If w/o budget, kindly specify what account
will be offsetted for this transaction)

REQUESTOR
Issued by: Checked by: Approved by: Verified by: Approved for Payment:

ANTHONY C. RECILLA ELMER IAN PARIS


Requestor Immediate Superior Manager CCO/CFO Finance CEO
= & Php20K below above Php20K Php20K above

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