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| Furnizor BRAICOOP COOPERATIVA AGRICOLA

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| DISPOZIŢIE DE LIVRARE |
| ___________________________________ |
| | Nr............................... | |
| | Data (ziua, luna, anul) ......... | |
| |___________________________________| |
| |
| Veţi elibera produsele de mai jos către ............................... |
| prin delegatul ............................. cu delegaţia nr. ......... |
| buletin de identitate seria ...... nr. ....... emis de ................ |
| |
|_________________________________________________________________________|
|Nr. | | U/M | Cantitatea | |
|crt. | Denumirea produselor | |____________________| Preţul unitar |
| | | | Dispusă | Livrată | |
|_____|________________________|_____|_________|__________|_______________|
| 0 | 1 | 2 | 3 | 4 | 5 |
|_____|________________________|_____|_________|__________|_______________|
|_____|________________________|_____|_________|__________|_______________|
|_____|________________________|_____|_________|__________|_______________|
|_____|________________________|_____|_________|__________|_______________|
|_____|________________________|_____|_________|__________|_______________|
|_____|________________________|_____|_________|__________|_______________|
|_____|________________________|_____|_________|__________|_______________|
|_____|________________________|_____|_________|__________|_______________|
| Semnătura | Dispus livrarea | Gestionar | Primitor |
|_______________|_______________________|_______________|_________________|
14-3-5A A5 t2

(verso)
________________________________________________________________________
|Nr. | | U/M | Cantitatea | |
|crt. | Denumirea produselor | |____________________| Preţul unitar |
| | | | Dispusă | Livrată | |
|_____|________________________|_____|_________|__________|_______________|
| 0 | 1 | 2 | 3 | 4 | 5 |
|_____|________________________|_____|_________|__________|_______________|
|_____|________________________|_____|_________|__________|_______________|
|_____|________________________|_____|_________|__________|_______________|
|_____|________________________|_____|_________|__________|_______________|
|_____|________________________|_____|_________|__________|_______________|
|_____|________________________|_____|_________|__________|_______________|
|_____|________________________|_____|_________|__________|_______________|
|_____|________________________|_____|_________|__________|_______________|
|_____|________________________|_____|_________|__________|_______________|
|_____|________________________|_____|_________|__________|_______________|
|_____|________________________|_____|_________|__________|_______________|
|_____|________________________|_____|_________|__________|_______________|
|_____|________________________|_____|_________|__________|_______________|
|_____|________________________|_____|_________|__________|_______________|
|_____|________________________|_____|_________|__________|_______________|
|_____|________________________|_____|_________|__________|_______________|
| Semnătura | Dispus livrarea | Gestionar | Primitor |
|_______________|_______________________|_______________|_________________|