Record Of Telephone Price Quotations - Indiana Department Of Child Services
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1RECORD OF TELEPHONE PRICE QUOTATIONS
State Form 43464 (R3 / 12-97)
Approved by State Board of Accounts 1998
Name of facility / institution
UNIT COST
VENDOR
VENDOR
VENDOR
NUMBER 1
NUMBER 2
NUMBER 3
QUANTITY
ITEM AND NUMBER
BRAND
DESCRIPTION
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
JUSTIFICATION FOR SELECTING A VENDOR
1. Name of vendor
Name of contact person
Minority?
Yes
No
Address (street, number or rural route)
Telephone number
(
)
City, state and ZIP code
Date contacted (month, day, year)
2. Name of vendor
Name of contact person
Minority?
Yes
No
Address (street, number or rural route)
Telephone number
(
)
City, state and ZIP code
Date contacted (month, day, year)
3. Name of vendor
Name of contact person
Minority?
Yes
No
Address (street, number or rural route)
Telephone number
(
)
City, state and ZIP code
Date contacted (month, day, year)
Name of person receiving price quotations
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