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. ,��mp►d��r�ss�i�ns��i'Y e�sA�� <br /> A7yco lnfernetivnal Comp�ny <br /> P ment Re uisNfon Fonn <br /> ?h{s torm is to be used p�when paymenl is requtrect�j an involce{s pp�avaAabte(i.o.pormite,dra►�ngs,blds).lf you have an imolca, <br /> foflow ihe inslrocUons supplled ln ihe towsr dpfit fiand oorner of thta fam <br /> Complele arM save thfs forrr►In Excel formal. "FMs torm Is no!to be pAnted oul. Click J-tet�for fufther lnsiruCiions <br /> P�ovkle a daleNed resson tor ihis p�yment. <br /> Tha oorrect vendor number,oost diatribuUon InFomtalion and approvaEs mual be snpplted. Requesls aubmltied w11h lnconoclAncomplete _ <br /> deteils or inadequate approval will be returned. <br /> Related bactc-up Is to be aupplEed in a seperaEa PD�document <br /> This corn�Jotc+d form and u�r relatad back•up is to ba emalled b a+nanager(or hisA�er emalled approval � <br /> Payment wlil be made based on Payment Terms ln the Vendor Master syalem.Exceptfone wifl requlre addllfo»af approval.(RM<$26k or <br /> VP>S26k) <br /> Note:Purnhases ot non-inventary ltems ot$500 or less ahould be chargad lo Ihe Putchasing Card.See Purchasing Gerd Marn�a1/ound at Ihe <br /> �nk belavr for delaUs. <br /> �lk.lc here a�the Purchasin��Manual for f��rihet detatls <br /> �...�.. <br /> Requesf Date: 03/93t13 os s r ut on • - <br /> Requeator: �Wanda paradis Ail Componsnls of Selected Cociing Type <br /> Must be Supp)led-Form w111 be Retumed if <br /> Telephone No. a13-313-7811 Incorreci or lncom lete <br /> Fax Number: 813-68�1-7731 Pro Num Ctri D[st $Amt <br /> :a�:s r•s;c•r�::F;Fi c ;c':'c,r :s't':': : .• •. <br /> Vendor Number: OG6313 •,:€:i:,:::,��i:;.....,�l�:=1=:::,:,:�;�Fi:::i:�:i:lI�9�3`•s,3;�::i:i.�:::i s; <br /> Acct Num De t Dlst Amt <br /> 82447 852 292 ' 75.00' " <br /> ';iY;i;i�;�i:;Jiii?ii{iiiij:i�=i=i:i:;i�i;i�:•iii=iji';titi�i=i�i�:!1 i?ij'�"�'? <br /> Aay-to Vendor Nsme: City af Zephyrhlils Canada 7ax$Amount: <br /> Remit Address Llne 1: &33B Sth Street <br /> Rernit Address Ltna 2: � Mulliple Ilne dlslr(butlon. <br /> City I State I Ztp: Zeghyrhil3s,FL 33642 See noxt page for breakdown. <br /> Pay[nentAmount; $ 76.00 �� <br /> . +��� f <br /> Reason for Aa ment do not su I an Custaner or Pro ect names <br /> )ns eclion fea for Ze ty rhills Florida. <br /> Check wil!f�a cut an tho next 7uesday or ThursQay untess a detalted buslness jusfificatEon is supplled below <br /> !t check must be aut and sent to you the same day the request ls submNted,auppty the detalted reason in fhe <br /> "Reason for Same t3ay Paymont"fleid below.-Request needs to be recetved by AP by 10:00 AM ET to ensure - <br /> noxt da doltvo <br /> Det(ve Malhod: Mall ❑ FEDEX � <br /> � Daltver to Dleirtct lf an Ir�volce is available,ptease scan lhe <br /> D(strlct Number: 292 one tnvoice to a PDF documsnt lhen entalt to .. <br /> FedEx Contacf: Scott prackelt almptexgrEnnellUSA@nadocs.com for Ihe US or <br /> Perm�nent!1 per Distrlct lo sEmplexgrinnelicanada�nedcos.com for <br /> Dellver to Vendor Cansda. Do Not atlow the N!e to be Zlpped. <br /> Ve�dor Name: <br /> Confact: - <br /> Maf!-to Address Ltne 1: <br /> Mal}-to Address L1ne 2: <br /> Cily/Siate!21p: <br /> Tele hone: <br />