Purchase Order Form for pharmaceuticals


 Purchase Order Form



Order Date

COMPANY LOGO AND NAME
Shipping Date

PO Number

Vendor Number

Address:
Vendor Fax #

Vendor Name

Authorization number

Shipping Address:
Shipping charges
Paid: or collect:
Person Authorizing Return


Item #
Material Code
Approved Description
Qty. required
Vendor Invoice #
Unit Price
Total Amount
































































Reason for Return
Action Requested
Sub Total

1. Overstock
1. Repair and Return
Tax

2. Over-shipment on PO#
2. Repair and Bill
Handling / Shipping Charges

3. Substitution on PO #
3. Replace at no Charge
Total

4. Defective
4. Issue Full Credit

5. Other
5. Other



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