Artemis Society International
                             Purchase Request


P.O. #:      ___________
Date:        ___________

Vendor:      ___________                   Voice # (___) ___-____
             ___________                   Fax #   (___) ___-____
             ___________
             ___________

Date Needed: ___________
Terms:       ___________

Ship to:     ___________                   Ship Via: ____________
             ___________
             ___________
             ___________

Confirm to: ______________________________ Bill to:  Artemis Society
            ______________________________            International
            ______________________________           P.O. Box 940825
            ______________________________           Plano, TX  75094-0825
            ______________________________           (972) 516-1774
__________________________________________________________________________
| Item | Qty |           Description              | Price ea | Ext Price |
|------|-----|------------------------------------|----------|-----------|
|      |     |                                    |          |           |
|------|-----|------------------------------------|----------|-----------|
|      |     |                                    |          |           |
|------|-----|------------------------------------|----------|-----------|
|      |     |                                    |          |           |
|------|-----|------------------------------------|----------|-----------|
|      |     |                                    |          |           |
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|      |     |                                    |          |           |
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                                                   Shipping  |           |
                                                             |-----------|
                                                     Total   |           |
                                                             |-----------|
                                         G/L
Requested By:        __________          Code(s) _______ Amt  ___________
Budget Code:         __________                  _______      ___________
Manager Approval:    __________                  _______      ___________
Purchasing Approval: __________                  _______      ___________