Virginia Polytechnic Institute and State University s2

REQUEST FOR FAX QUOTE # (THIS IS NOT AN ORDER) RETURN FAX NUMBER (276) 328-0269

The UNIVERSITY OF VIRGINIA'S COLLEGE AT WISE PROCUREMENT SERVICES RESOURCE CENTER on DARDEN DRIVE 1 COLLEGE AVENUE WISE, VA 24293-4412 DATE RESPOND BY: IMMEDIATELY (If your response is not received in 24 hours, your quotation may not be considered) From:

ITEM # DESCRIPTION QUANTITY UNIT UNIT PRICE TOTAL 1 2 3

* The University of Virginia’s College at Wise is a tax-exempt organization. Form available upon request. **This solicitation is subject to the provisions of the Commonwealth of Virginia General Terms and Conditions, the DPS/DGS Vendors Manual, and Special Terms and Conditions as attached.

TO: FULL LEGAL NAME (PRINT) FEDERAL TAXPAYER NUMBER (ID#) DELIVERY DATE (Company name as it appears with your Federal Taxpayer Number)

BUSINESS NAME/DBA NAME/TA NAME FEDERAL TAXPAYER NUMBER PAYMENT TERMS (If different than the Full Legal Name) (If different than ID# above) Net 30

BILLING NAME FEDERAL TAXPAYER NUMBER (Company name as it appears on your invoice) (If different than ID# above)

PURCHASE ORDER ADDRESS PAYMENT ADDRESS

CONTACT NAME/TITLE (PRINT) SIGNATURE (IN INK) DATE

E-MAIL ADDRESS TELEPHONE NUMBER TOLL FREE TELEPHONE NUMBER FAX NUMBER

THIS IS NOT AN ORDER