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Order Recipient

Enter the name and contact information of the individual who will be receiving this order.

Phone Format: XXX-XXX-XXXX

Billing & Payment

California State Billing Requirements

Charge Against

Statute Format: 'YYYY'
Item Format: 'Agency Code - Reference Code - Fund Code' (XXXX-XXX-XXXX)

Certification of Approval of Executive Officer (CA Form 65 Only)

I HEREBY CERTIFY, on my own personal knowledge, that this order for the purchase of the items specified above is issued in accordance with the procedure prescribed by law governing the purchase of such items for the State of California; that all such legal requirements have been fully complied with.


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