| Bill To: | Purple | Ship To: | |||
|---|---|---|---|---|---|
| PO#: | Ft. Dix: | Store Name | Ft. Dix: | ||
| Rep Name: | Paul | Attention: | Boon Dye | ||
| Rep Phone #: | 111-111-1111 | Address: | 623 Third Street | ||
| PM Bank #: | – | Phone #: | 609-513-3569 | ||
| Order Date: | October 28, 2025 at 11:21 am | Requested Ship Date: | Standard Lead Time – | ||
| Qty | Item # | Description | Product Price | Product Total |
|---|---|---|---|---|
| 2 | F009544 | F009544 – 2024 Purple (Essential) Foot Protector – Queen – | $55.04 | $110.08 |
| Please review Quantity | ||||
| Approved By: | ||||
| Order Total: $110.08 |