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Printer Lease Program - Phase 4
:
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Please Note
... Do
NOT
print this form and use a typewriter to complete. Simply type in your information
while on the web and click on the "Save and Close" button above. If you do not follow this procedure we
will not have a record of your order.
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User Name
*
Authorized Purchasing Requestor
*
Authorized Purchasing Requestor E-mail
*
CED/Dept Head
*
Lease/Purchasing Information
*
Method of Payment
*
Account Numbers
Area
Funds
Cost Center
DREF
(2 digits)
(8 digits)
(10 digits)
(10 digits)
County/Dept
*
Address To
*
Street Address
*
City
*
State
*
Zip code
*
Order Item & Quantity
Annual Lease Price
(per year for 3 years)
Network Printer - Qty.
*
Color Network Printer - Qty.
*
*
indicates a required field