Free 43464.PDF - Indiana

RECORD OF TELEPHONE PRICE QUOTATIONS
State Form 43464 (R3 / 12-97) Approved by State Board of Accounts 1998

Name of facility / institution

UNIT COST BRAND DESCRIPTION VENDOR NUMBER 1 VENDOR NUMBER 2 VENDOR NUMBER 3

QUANTITY

ITEM AND NUMBER

1. 2. 3. 4. 5. 6. 7. 8. 9. 10.
JUSTIFICATION FOR SELECTING A VENDOR

1. Name of vendor

Minority?

Name of contact person

Yes
Address (street, number or rural route)

No
Telephone number

(
City, state and ZIP code

)

Date contacted (month, day, year)

2. Name of vendor

Minority?

Name of contact person

Yes
Address (street, number or rural route)

No
Telephone number

(
City, state and ZIP code

)

Date contacted (month, day, year)

3. Name of vendor

Minority?

Name of contact person

Yes
Address (street, number or rural route)

No
Telephone number

(
City, state and ZIP code

)

Date contacted (month, day, year)

Name of person receiving price quotations