Smith and Associates Environmental Health and Safety Consulting Services

(510) 670-0809

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Green Supply Chain Purchasing Authorization Form

Purchase Authorization & PO Number Request

General Terms & Conditions: A Smith & Associates Purchase Order Number is required to process all requested orders. Pre-payment is required of your Green Supply Chain Purchase using Direct Deposit. Once your request has been submitted you will receive a Purchase Order Number.

An approved supplier is required to process all orders. If you have not received approval for the supplier please fill out the Supplier Request Form. Once your requested supplier has been approved you may fill out the form below. 

After payment authorization has been made provide your assigned PO# to the approved supplier to process and complete your order. The client will be financially responsible for all invoice adjustments, tax, shipping, hazmat, supplier orders, and returned orders, made by client and or client employees. Smith & Associates is not responsible for order or shipping errors. Orders shipped to Smith & Associates Castro Valley, CA in error will be returned to the supplier, postage and or shipping fees will apply. Purchasing Requests will be processed Monday - Friday between 8:00 am – 4:30 pm PST  

*Required Field

Client Company Name:
Contact Name:
Contact Phone Number:
( ) -
Contact Email Address:
Approved Supplier Name:
Project Name:
Job Number:
Confim that shipping address
has been provided to supplier:
Rush Order (mandatory same day shipping):
Supplier Invoice Estimated Grand Total Amount:
$25.00 Service Charge for Orders under $1000.00
I authorize payment & agree to the
General Terms & Conditions above:
Pay with Bank Account information on file:

For the Purchasing Help Desk please contact Accounts Receivable at (510) 670-0809 (9:00 am – 5:00 pm PST) or email admin@smith4safety.com.



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