PO.doc

Commonwealth of Massachusetts

Purchase Order for Commodities and/or Services

Commodity/Equipment

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Service this purchase order confirms an order that was previously placed. please do not duplicate.

*Purchase Order Issue Date:

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*Purchase Order Number:

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Contract Number:

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Requested Delivery Date:

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Call to Schedule Delivery Appointment:

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yes (tel.

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no Freight Terms:

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Freight on Board - Destination

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Other (Specify)______________

Vendor Information

*Name:

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*Address:

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*City, State, Zip Code:

Contact Person:

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Telephone:

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Fax:

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Email:

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Quote Number (if applicable):

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Department Information

*Ship to Department Name:

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*Contact Person:

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*Address:

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*City, State, Zip Code:

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*Telephone:

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Email:

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Delivery Instructions:

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*Bill to Department Name:

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*Contact Person:

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*Address:

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*City, State, Zip Code:

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Telephone:

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Email:

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Prompt Payment Discount (Terms & %):

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Instructions to the Vendor:

1. The vendor’s invoice must include the following minimum information: Purchase order number, quantity and description of item(s) shipped, unit of measure, unit price, total dollar amount of any discount, total price and the vendor’s invoice number.

2. The purchase order number must appear on the vendor’s packing list.

3. See attached specifications, if any, related to this purchase order. If this purchase order is for services, please see the section entitled Engagement of Services below. Additional specifications are not necessary if the details of the performance are covered in the contract.

4. Vendor assumes risk of loss for commodities in transit. All commodities are subject to inspection upon delivery. Commodities delivered after the Requested Delivery Date above may be rejected. Rejected commodities will be returned at the vendor’s expense.

* Engagement of Services (may be required for services): If this Purchase Order is for the provision of services which have been negotiated with the vendor, provide a brief description here of those services (attach detailed specifications, if appropriate). Also, include the dates of service, the number of hours and the hourly rates associated with this engagement. The vendor must sign this form for the engagement of services. Note: This form or additional specifications are not required if the RFR and contract contain all of the required Purchase Order information.

Description

Department Approval

Signature: _________________________________ *Printed Name:

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*Date:

Subtotal:

Shipping and Handling:

Total Order Amount:

* Vendor Approval (only required for the Engagement of Services) *Signature: ________________________________ *Printed Name:

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*Date:

* Indicates required field.

** Discount includes any Prompt Payment Discounts.