PURCHASE REQUEST

Barangay VICTORY P.R. No.: 101-19-03-

City/Municipality TALALORA Date:
Province SAMAR

REQUISITION
Item Unit Estimated Unit
Qty Item Description Estimated Amount
Number Measurement Cost

Total Estimated Amount

Purpose:

Requested by: Approved:

_____________________________ HON. ROGELIO CAMUEN

Signature Over Printed Name Signature Over Printed Name
Requesting Officer Punong Barangay

__________________ ________________
Date Date