State Form 37168 - Indot Quantity Purchase Award Release

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INDOT QUANTITY PURCHASE AWARD RELEASE
Page number
Total number of pages
OF
Vendor’s name
Fund
Object
Center
Purchase order number
and
Address
Name and number of requesting agency
Requisition number
INDOT - 800
INDOT - 800
Remit to:
Document I.D.
Transaction date
Date purchase order issued
Requested by and bill to:
REMIT TO FED. I.D.#
1099 CODE
Ship to:
LN
REFERENCE DOCUMENT
Invoice Number
Job/Project
Prty.
Fund
Agcy.
Orgn.
Appr.
Actv.
Obj.
Amount
Partial/
CD
Number
LN
Number
Unit
Final
01
RQ
01
01
PO
01
Ln#
Qty.Req.
Unit
.
UNIT PRICE
AMOUNT
Qty.Rec
ARTICLE and DESCRIPTION
Receipt of Supplies/services required by
business days ARO
PRICED PER CONTRACT AGREEMENT NUMBER
EXPIRATION DATE:
TOTAL
.
.

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