Cooperative Purchasing Quarterly Usage Report

*Membership #:	Required
*Report Quarter:	Required		*Report Year:	Required
*Entity:	Required
*Address:	Required
*City	Required	*State:	Required	*Zip:	Required Invalid zipcode.
*Contact First Name:	Required	*Contact Last Name:	Required
*Phone:	Required	Fax:
*E-mail Addr:	Required Invalid Email Address.

Enter/Add Item

*Date Purchased:	Required Invalid Date
*Contract Number:	Required	*Contractor Name:	Required
*Amount:	Required Invalid Dollar Amount	*Estimated Dollar Saved:	Required Invalid Dollar Amount
*Item Description:	Required
*PO Number:	Required
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If you wish to retain a printed copy of this report, you should do so PRIOR TO submitting it.
You will receive a confirmation email with the information provided in this report once it has been submitted.

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