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BILL NO. Department, establishment, bureau, or office receiving funds PAID BY Department, establishment, bureau, or office charged ORDER NO. DATE OF DELIVERY ARTICLE OR SERVICES QUANTITY UNIT PRICE COST UNIT PRICE PER AMOUNT DOLLARS & CENTS $0.00 $0.00 $0.00 $0.00 $0.00 TOTAL $0.00 $0.00 Remittance in payment hereof should be sent to- ACCOUNTING CLASSIFICATION - Office Receiving Funds CERTIFICATE OF OFFICE CHARGED I certify that the above articles were received and accepted or.

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