Company Name: Reporting Calendar Year: Revision CMAS Number: Reporting Quarter: Q1 (Jan-Mar) For Questions Regarding this Report Contact: Q2 (Apr-Jun) Name: Q3 (Jul-Sep) Phone Number: Q4 (Oct-Dec) Check Here if No New Orders for This Quarter E-mail: Purchase Order Purchase Order Total Dollars Per State Agency Name Agency Contact Agency Address Phone Number Number Date Purchase Order Total State Agency Dollars Reported for Quarter: $ LOCAL GOVERNMENT AGENCY PURCHASES Purchase Order Purchase Order Total Dollars Per Local Government Agency Name Agency Contact Agency Address Phone Number Number Date Purchase Order Total Local Government Agency Dollars for Quarter: $ 1% Remitted to DGS (does not apply to CA certified S/Bs): $ Total of State and Local Government Agency Dollars Reported for this Quarter: $
Company Name: CMAS Number: For Questions Regarding this Report Contact: Name: Phone Number: E-mail: Reporting Calendar Year: Revision Reporting Quarter: Q1 (Jan-Mar) Q2 (Apr-Jun) Q3 (Jul-Sep) Q4 (Oct-Dec) Check Here if No New Orders for This Quarter State Agency Name Purchase Order Number Purchase Order Date Total Dollars Per Purchase Order Agency Contact Agency Address Phone Number Total State Agency Dollars Reported for Quarter: $ LOCAL GOVERNMENT AGENCY PURCHASES Local Government Agency Name Purchase Order Number Purchase Order Date Total Dollars Per Purchase Order Agency Contact Agency Address Phone Number Total Local Government Agency Dollars for Quarter: $ 1% Remitted to DGS (does not apply to CA certified S/Bs): $ Total of State and Local Government Agency Dollars Reported for this Quarter: $
CMAS%20QR%20Form%20(122017).docx