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FEB -08 -2810 10 :19 From: 2398961695 2398961695 To:919787314671 <br /> Pa9e:1 2 <br /> Fire & SimplexGrinnell LP <br /> security 50 Technology Drive <br /> SlinplexGrinnel/ Westminster, MA 01441 <br /> (978) 731 -2500 <br /> AP FAX: (978) 731 -7756 <br /> Payment Requisition Form I <br /> This form is to be used g_nly when payment is required and an invoice is= available ( i.e. permits, drawings, bids). If an Invoice Is <br /> available please go through the standard payment procedures for submitting Invoices to accounts payable. <br /> Please provide a detailed reason for payment and attach any available back up when submitting request. <br /> Please supply vendor number. If not available, send an email to sg.apinquirygtycoint.com. Please fill in "Request for vendor number" in the <br /> subject line. Reference the full remit -to address in the body of the email. You will receive either a response with the Current vendor number <br /> or information on how to have the new vendor setup. <br /> This payment will be made per system payment terms. Exceptions will require additional approval. (AM a $25k or VP . $25k) <br /> Noto: Signature cards must be on file with Accounts Payable for all approvers stating their approved dollar limit. <br /> Request Date: 02/08/10 <br /> Cost Distribution <br /> Requester: Mike Snyder Pro' Num Ctrl Dist $ Amt <br /> Email Address: misnyderOsim rJlexarinnell.com r <br /> :!s ,,;;� ^ti ;,' ;';,'�. <br /> Fax ������� }�t'���4;y'Fi!��'�' }.4 i1 {StiGi: '�!� {�5. '1i1 ri5��51!45 X5 ' ! 54 ; � } 5 { {{ ii'�ii5 ^� :j <br /> ax Number: 813 -1731 <br /> Acct Num � � � >;., ,,,;i ;I .�'���ii #� €'w��, � "�'',:'�,,, 5 <br /> ���� fi5'!i'1�:i ii4.�A .l i.L { �, � '� hA� iii }1 i <br /> ' l 1 :i5 <br /> Vendor Number: 056313 ti14; 4 „ 51010 ,� Dept <br /> KH510 f Dist 709 25.00 <br /> .L'.', }''I��(ti;Ri� {ti1'y��'ii' ?a'ri'l �'S1 {�ii� }'�� �5r” 17;S�til'pi� $ Amt <br /> �� ?� "';'';'q'a r'x���. <br /> }fi�,� ;�,; },. i, ;kdfi'ivl,�' ?s''R' Si,U� y l i /'rrr wr 4,'41d ?I4 ?yr,'n 1i <br /> Pay -to Vendor Name: City of Zephyrhills PO Num $Amt <br /> Remit Address Line 1: 5335 8th Street ---,------- <br /> Remit Address Line 2: <br /> City / State / Zip: Zephyrhills, FL 33542 Q Multiple line distribution, <br /> See next page for breakdown. <br /> Payment Amount: $ 25.00 <br /> Reason for Payment: <br /> Need by Date: 02/11/10 Inspection Permit For Zephyrhills Hosp. <br /> Checks will be cut on Tuesdays & Thursdays <br /> "ASAP" will default to Wednesday or Friday delivery. <br /> Please Note: Purchases of non- inventory items of $500 or Approval <br /> Tess should be charged to the Purchasing Card. See Print Name: Mary Vogt <br /> Purchasing Card Manual found at the link below for details. Title: Office Manager <br /> http:// sirnplexorinnell- ia/ Cor0Services /CreditCardPrograms /CardCon Signature: f / <br /> tent /Purchsingcard Man ual.pdf � <br /> Date: 0210811 P 1 - <br /> Delivery Method: U.S. Mail ❑ FEDEX Additional Approvals (when applicable) <br /> IN Deliver to District <br /> District Number: 709 / SG 292 Print : Name; <br /> FedEx Contact: Mike Snyder Titlee <br /> Permanent / 1 Per District Signature: <br /> O Deliver to Vendor <br /> Vendor Name: Date: <br /> Contact: <br /> Print Name: <br /> Mail-to Address Line 1: <br /> Mail -to Address Line 2: Title: <br /> City / State / Zip: <br /> Telephone: Signature: <br /> Date: <br />