DISTRIBUTOR'S ORDER Form

Name Of Company/ Individual (s):
Address of Company/        Individual (s):
Date of Requisition:
Name and Rank of Person making requisition:
Quantity last bought:
Quantity now required:

Proposed date for supply:

Price for collection by buyer:
Price for Ex-factory Delivery:

	FOR OFFICE USE ONLY BILLING.
Purchase Order #
Account Name Account Number:

Mode of payment:	Cash  Cheque  Bank Draft  Other forms of transfer
Receipt No:
Address for delivery:	Ex-FACTORY DELIVERY
City:
State:
Country:

`                RECEIVING AGENT OF BUYER

          Products received in good condition By: (Please state name and rank)

           Name:    Rank:

         .........................................                                       .......................................

            Signature of client:                                                                      Signature of staff:

                                                                           (Julie's Formula representative)