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DocuSign Envelope ID:374F5A5F-BEFF-427E-A19B-5908655B3656 <br /> P.O. REQUISITION REQUEST FORM <br /> DATE; 01/11/181 1 Facility Services <br /> REQUESTED BY; IFreddy Brooks <br /> VENDOR NUMBER; <br /> VENDOR NAME: lAtlantic Spas and Billiards <br /> Account Number: <br /> Supplies 10240520-620000 <br /> Contract Services 10240520-630000 <br /> Capital Equip. 10240520-800000 <br /> DESCRIPTION ACCOUNT# QUANT$!UNIT $TOTAL <br /> $0,00 <br /> s <br /> Disassemble 630000 3 $250.00 $750.00 <br /> Reassemble 630000 3 $325.00 $975,00 <br /> Packet 630000 1 $100.00 $100.00 <br /> $0.00 <br /> $0.00 <br /> $0.00 <br /> $0.00 <br /> $0.00 <br /> $0.00 <br /> $0.00 <br /> $0.00 <br /> $0.00 <br /> $0.00 <br /> $0.00 <br /> $TOTAL $1,825.00 <br /> NOTES: <br /> Copy of REQUISITION6.xls <br />