Purchase Order No: ________________________________            Work Order No:___________________________________

Invoice No: _______________________________________              Received From: ___________________________________

Invoice Amount: ___________________________________            Received At: _____________________________________

Shipped By: _______________________________________            Prepaid:  ____________              Charges:  $____________

__________________________________________________           Collect:  ____________               Charges:  $_____________

__________________________________________________

P.O. ITEM	QUANTITY RECEIVED	STOCK NUMBER	UNIT OF MEASURE	DESCRIPTION	CONDITION

Comments (Explain damages, shortages, substitutions, etc.)

Action to be taken

___   COMPLETE ORDER ________________________________________  RECEIVED BY ________________   DATE

___   COMPLETE ORDER   _______________________________________  RECEIVED BY _________________   DATE