Purchase Order Request

Government Purchase Order Request Form

Thank you for your interest in Orionis_Grp products. Please provide the following information for your purchase order request:

Contact Information

Agency/Department: ___________________________

Contact Name: ___________________________

Title: ___________________________

Email: ___________________________

Phone: ___________________________

Billing Address:

___________________________

___________________________

Purchase Order Details

PO Number: ___________________________

Budget/Contract Number: ___________________________

Requested Delivery Date: ___________________________

Delivery Address:

___________________________

___________________________

Product Requirements

Amazon Product Links:

Please paste the full Amazon URL(s) of the product(s) you need:

1. ___________________________

2. ___________________________

3. ___________________________

4. ___________________________

5. ___________________________

6. ___________________________

7. ___________________________

8. ___________________________

9. ___________________________

10. ___________________________

11. ___________________________

12. ___________________________

13. ___________________________

14. ___________________________

15. ___________________________

Quantity for Each Product:

1. Qty: _____ 2. Qty: _____ 3. Qty: _____ 4. Qty: _____ 5. Qty: _____

6. Qty: _____ 7. Qty: _____ 8. Qty: _____ 9. Qty: _____ 10. Qty: _____

11. Qty: _____ 12. Qty: _____ 13. Qty: _____ 14. Qty: _____ 15. Qty: _____

Additional Product Description/Model Numbers:

___________________________

Special Specifications/Requirements:

___________________________

Additional Information

Special Instructions:

___________________________

Preferred Payment Terms: ___________________________

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Next Steps

Once you complete this form, please:

1. Email the completed form to: [Your Email]
2. Include the Amazon links for exact product specifications
3. We will source the products and respond within 2 business days with pricing
4. Upon approval, we'll create a secure checkout link for payment

Contact Information:
Email: [Your Email]
Phone: [Your Phone]
Business Hours: [Your Hours]