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__________________________________________________________

Name of Supplier

__________________________________________________________
Address

________________________________________
TIN #

DELIVERY RECEIPT
No.:__________
Delivered
_________________________________________
to:
Date: ____________________
Address:
_________________________________________
Terms: ___________________
________________________TIN # __ Delivered by: _____________
QUANTITY

UNIT

DESCRIPTION

UNIT PRICE

THIS DOES NOT SERVE AS AN INVOICE


Check and Certified by

Received the above merchandise in good order and condition.

Signature over Printed Name

Signature over Printed Name

Dealer/Representative

Supply Officer

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