Ship To:
Attn:
Phone:
Fax:
ITEM QTY
UNIT PRICE EXTENDED PRICE
FUND ORG ACCT Shipping
TOTAL
BREIF DESCRIPTION
PO #:
Date:
Vendor Name & Address
FAIRMONT STATE UNIVERSITY
1201 LOCUST AVE
FAIRMONT, WV 26554
(304) 367-4711
CREDIT CARD
ORDER FORM
CONTRACT # (If applicable)
RECEIVED BY:
AUTHORIZED BY:
AMOUNT
OASIS Trans ID
C
B
A
$ 0.00
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