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. DEPARTMENT ORDER WORKSHER'T . <br /> ORDER NO.. <br /> . . <br /> - <br /> DVSW 2Z . GErIERAL DESCRIPTION /,c? ~~s ~ • ; <br /> Authorized by ,Q.~,• .Pay with - attached~`invoice S(~ <br /> • - Received by ~ ~ R.S~) • - .Prepayaiefit r=- ~ ' • <br /> Date. merchandise received - ~ - Eme _r - ~ - <br /> r5ency,``' <br /> <br /> ~ - .Separate Check . <br /> Vendor name and address if not on invoice - Route to:- <br /> vendor Code . <br /> ~ - - Commodity code 34 - S~r~ <br /> Qu~~ty Onit Price $ Total $ - <br /> Description ~ e S ~12 r «N . <br /> • <br /> - • ~ ~ ~ .y. <br /> • <br /> . . <br /> Account Code ACCOUAt AtilOU(It <br /> ...0 <br /> ~t2- ~3' 32 ~2~i~ - ~8 Si $ 28D <br /> • $ <br /> $ . <br /> _ _ _ _ <br /> S <br /> .Page of <br /> <br />