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O. 367 Div. No. APO No. 97002 Check One Box: Goods Rcvd Document Date: 07 / 01 / 03 / Effective Date: / Current Doc. No. VO 04 / Due Date: x Purchase Order / Purchasing Agency Name & Address Vendor Alpha Prefix Local Enc. # xxx Send Invoice to: Kansas State University Department Name Contact: Contact Person Phone:( xxx ) xxx - xxxx Department: Vendor Information No/Sfx Vendor ID Name Street City,St. & zip Payment Indicator Name of Faculty or Staff Member Home Address Shi.

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