Purchase Request Number: $van[1]

^{DATE OF
ORDER:}

^{VENDOR NAME}

CONFIRMING TO: P.O. NUMBER

^ADDRESS

^{CITY/STATE/ZIP} $van[20] TELEPHONE NO.

VENDOR NUMBER:

PAYMENT TERMS: SHIP VIA: TAXABLE:

YES NO

^{DATE
REQUIRED:} INCOTERMS:

^{DATE PROMISED:} REQUESTOR COMPLETE THIS SECTION ONLY ITEM NO: ACCT. NO: QUANTITY DESCRIPTION UNIT PRICE TOTAL "; $ralph=$van[48]; $sql33f ="SELECT * FROM $table_name103 WHERE map_id ='$map_id' "; $result33f = @mysqli_query($connection,$sql33f) or die(mysqli_error($connection)); $nbr_ligne88 = mysqli_num_rows($result33f); $nbr_ligne1=$nbr_ligne88; $nbr_ligne=$nbr_ligne1; //$nbr_ligne=2; // if ($nbr_ligne=$blink){ //$nbr_ligne=0; // } $m=20; for ($i=0; $i<$m; $i++) { $j=$i+1; $borg=${PB.$i}; //$borg1=GL[$borg]; // $pete=$tod[$i]; // Display only the first line if ($nbr_ligne == 0) { $nbr_ligne = 1; } if ($i >= $nbr_ligne) $display = 'style="display:none"'; // $prod22 .=" [+] "; } $display_form2 .="

Total

^{DELIVER TO THE FOLLOWING
PERSON:}

EXTENSION NO:

$van[22]

^REQUESTOR:

^{EXTENSION NO:}

^{DATE of Request:}

^{DATE REQUIRED:}

Email:

Department: Parts Customer Service Service Sales Accounting Logistics Production Other APPROVAL DATE: Approval Status: Send for approvals: Signature / Electronic Signature YES NO

^{APPROVAL DATE:}

^{Approval Status:}

Final Approval

Signature / Electronic Signature

YES NO

ATTACH SUPPORTING DOCUMENTATION

"; ?>