PURCHASE REQUEST

________MUNICIPALITY OF SASMUAN________
LGU

Department: MAYOR’S OFFICE______________ PR No: ____________ Date: _________________

____________________________ SAI No.: ___________ Date : __________________
ALLOBS No.: _______ Date: __________________
Section : ____________________________

Item Unit of Estimated Estimated

No. Quantity Issue Item Description Unit Cost Cost

Purpose:
_____________________________________________________________________________________
_____________________________________________________________________________________

Requested by: Cash availability: Approved by:

Signature :
Printed Name: NARDO M. VELASCO LUCILA G. SONGCO NARDO M. VELASCO
Designation: Municipal Mayor Muncipal Treasurer Municipal Mayor
PURCHASE ORDER
MUNICIPALITY OF SASMUAN
LGU
 P.O. No. : ________________________
Supplier : Date : ___________________
Address : Mode of Procurement : _____________
PR No.: __________________________

Gentleman:

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: _________________

Item Unit Quantity Description Unit Amount

No. Cost

Total Amount in Words

In case of failureto make the full delivery wihtin the time specified above, a penalty of one-tenth(1/10) of one percent for
every day of delay shall be imposed.
Very truly yours,

Conforme: Hon. NARDO M. VELASCO

(Auhtorized Official)
_____________________________
(Signature over printed name)

_______________________
(Date)

(In case of Negotiation Purcahse pursuant to Section 369 (a) of RA 7160, this portion must be accomplished.)

Approved per Sanggunian Resolution No.: _____________________________________________________

Certified Correct: _________________________________ Date: __________________________

Secretary to the Sanggunian