EFTA00616350.pdf

LSJ Approval/Purchase Items/Payment Request Form Date of Request: 5-8-07 Status: Urgent: XXXX Inventory: Item/Items Requested: Tile for Cabana Floor 360 pcs. 12"x12" Mexican Santillo Tile S788.40 76 pcs. Pool edging-Mexican Santillo tile $604.20 Purchase Price: $1,392.60 shipping, tax and all related costs. Ship on our boat Total Expected Cost: $1,392.60 Deposit Required? Yes: Pay upon receipt. No: List Dept: Purpose/Description: Tile Floor at Cabana Purchased From: Floor Factory Company Name & St. Thomas Address or Web Site Requested By: Dan Chipman Time Frame for Purchase/Repair: Special Instructions: Attach Quote: Yes: No: XX Can fax a copy if needed Were Competitive Quotes Obtained? Yes: No: If No, Why Not: Authorization: EFTA00616350