Cash Purchase Order

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Cash Purchase Order
On Navajo County, Arizona
Description of Expenditure
8.
Vendor Name
2.
(Date)
MO
DAY
YR
3.
(Payment Date)
MO
DAY
YR
9.
5.
Vendor Remittance Address
Requisition Number
7.
10.
Purchase Order Number
6. ______ C ______ P
Vendor City, State, Zip
1099 – Y / N
Box # ________
ACCOUNT CODE
USE TAX
DEPT
SUB/
PAYMENT
TAXABLE
NON TAXABLE
FUND
DEPT
PROJ
OBJECT
SIGN
DEPT
AMOUNT
AMOUNT
/FREIGHT
11
12
13
14
15
16
17
18
19
20
FOR FINANCE USE ONLY
21. TOTAL AMOUNT PAID
INVOICE #’S
ORIGINAL INVOICES AND/OR RECEIPTS MUST BE ATTACHED
I certify that the item(s), material(s) and/or service(s) were received
and that the quantities are correct as stated herein, or on the invoices
attached.
Deputy Clerk Of The Board
SIGNATURE
Received-Date Only
Fund Name
Check Received By
Date
Approved By
Date
DEPARTMENT DATE STAMPS ONLY
FOR FINANCE USE ONLY

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