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_= = Payment Request Form <br /> All Fields Required (unless noted) <br /> ONVMS .Minor <br /> DC # 50 Payee # OM41531-1 <br /> Payee Name Ferman Mejia Invoice # 51 <br /> Payee Addr 1 Dba Mejias Lift Service Inv. Date 1 7/23/2020 <br /> Payee Addr 2 Po Box 6121 <br /> Expense Vendors Lookup Link <br /> Payee Addr 3 <br /> City, ST, Zip Stockton Ca 95206 <br /> PO Required <br /> Description Amount Cost Center G/L Account When Checked <br /> Lift repair 135.00 0050 5793035 <br /> Parts 68.40 <br /> Freight (If applicable) <br /> Tax (If applicable) 5.64 <br /> Total Amount 209.04 <br /> Special Instructions (optional) <br /> Requested By Robert Vargas - Operations Supervisor <br /> (signature or ch email) (Type Name and Title) <br /> Steve Day - Manager, Operations <br /> Approved By <br /> (signature or alta (Type Name and Title) <br /> Approved Date 8/11/2020 <br /> SCAN Original Invoice and Supporting Documentation along with this Request as a SINGLE PDF file <br /> DISTRIBUTION CENTERS should email the PDF to:GM-OMExpenseInvoices@owens-minor.com <br /> HOME OFFICE should email the PDF to: ExpensePayables@owens-minor.com <br /> Please reference the Instructions Tab for additional information <br /> V 02-06-19 <br />