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FOR FINANCE USE ONLY PAYMENT REQUISITION <br /> ORANGE COUNTY FINANCE OFFICE <br /> VENDOR # l VOUCHER # <br /> new <br /> PREPARED BY DATE October 19, 1987 <br /> This is to request that a check be drawn for the following valid and necessary expenditures of <br /> this department. <br /> Pay to the order of: Custom Business Forms Company <br /> P.O. Box 13547 <br /> Greensboro, NC 27415-3547 <br /> P.O.# Partial Full city state zip <br /> FOR FINANCE USE ONLY <br /> INVOICE DATE AMOUNT <br /> invoice disc. pay gross disc. net <br /> Account No. Description Amount <br /> 10-410-25 5000 sheets of letterhead 180.98 <br /> 10-590-37 Tax 5.43 <br /> • <br /> (Department Head) <br /> (Finance Director) <br />