Order for supplies or services




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ORDER FOR SUPPLIES OR SERVICES

PAGE       OF       PAGES

IMPORTANT: Mark all packages and papers with contract and/or order numbers.

1. DATE OF ORDER

     


2. CONTRACT NO. (IF ANY)

     


6. SHIP TO:


a. NAME OF CONSIGNEE      



3. ORDER #

     


4. REQUISITION/REFERENCE #

     


b. STREET ADDRESS      

c. CITY

     


d. STATE

  


e. ZIP

     


5. ISSUING OFFICE (Address correspondence to)

     


SHIP VIA:      


8. TYPE OF ORDER

7. TO:

 A. PURCHASE - Reference your      

Please furnish the following on the terms and conditions specified on both sides of this order and on the attached sheets, if any, including delivery as indicated.




 B. DELIVERY - Except for billing instructions on the reverse, this delivery order is subject to instructions contained on this side only of this form and is issued subject to the terms and conditions of the above-numbered contract.

a. NAME OF CONTRACTOR      

b. COMPANY NAME      

c. STREET ADDRESS      

d. CITY

     


e. STATE

  


f. ZIP

     


9. ACCOUNTING AND APPROPRIATION DATA

     


10. REQUISITIONING OFFICE

     


11. BUSINESS CLASSIFICATION (Check appropriate box(es))

 a. SMALL  b. OTHER THAN SMALL  c. DISADVAN TAGED  d. WOMEN OWNED



12. F.O.B. POINT      

14. GOVERNMENT B/L #

     


15. Deliver to F.O.B. Point on or before (Date)

     


16. DISCOUNT TERMS

     


13. PLACE OF:

a. INSPECTION      

b. ACCEPTANCE      

17. SCHEDULE (See Reverse for Rejections)

ITEM NO.

(A)


SUPPLIES OR SERVICES

(B)


QUANTITY ORDERED

(C)


UNIT
(D)

UNIT

PRICE


(E)

AMOUNT
(F)

QUANTITY

ACCEPTED


(G)

     

     


     

     


     


     

     


     

     


     


     

     


     

     


     


     

     


     

     


     


     

     


     

     


     


0.00

0.00


0.00

0.00


0.00


     

     


     

     


     


SEE BILLING

INSTRUCTIONS

ON

REVERSE


18. SHIPPING POINT

     


19. GROSS SHIPPING WEIGHT

     


20. INVOICE NO.

     


     

17(H).TOT.

 (Cont.


pages)

21. MAIL INVOICE TO:

a. NAME      

     

17(I).

 GRAND


TOTAL

b. STREET ADDRESS (or P.O. Box)      

c. CITY      

d. STATE

  


e. ZIP

     


22. UNITED STATES OF AMERICA

BY (Signature) 



23. NAME (Typed)

     


TITLE: CONTRACTING/ORDERING OFFICER

AUTHORIZD FOR LOCAL REPRODUCTION OPTIONAL FORM 347 (6/95)

Previous edition not usable Prescribed by GSA FAR (48 CFR) 53.213(e)





ORDER FOR SUPPLIES OR SERVICES

SCHEDULE - CONTINUATION


PAGE NO.


     




IMPORTANT: Mark all packages and papers with contract and/or order numbers.




DATE OF ORDER      

CONTRACT NO.

     


ORDER NO.

     








ITEM NO.

(A)


SUPPLIES OR SERVICES

(B)


QUANTITY

ORDERED


UNIT

(D)


UNIT

PRICE


AMOUNT

(F)


QUANTITY

ACCEPTED





     

     


     

     


     

     


     

     


     

     


     

     


     

     


     

     


     

     


     

     



     

     


     

     


     

     


     

     


     

     


     

     


     

     


     

     


     

     


     

     


     

     


     

     


     

     


     

     


     

     


     

     


     

     


     

     


     

     


     

     


     

     


     

     


     

     


     

     


     

     


     

     


     

     


     

     


     

     


     

     


     

     


     

     


     

     


     

     


     

     


     

     


     

     


     

     


     

     


     

     


0.00

0.00


0.00

0.00


0.00

0.00


0.00

0.00


0.00

0.00


0.00

0.00


0.00

0.00


0.00

0.00


0.00

0.00


0.00

0.00


     

     


     

     


     

     


     

     


     

     


     

     


     

     


     

     


     

     


     

     








TOTAL CARRIED FORWARD TO 1ST PAGE (ITEM 17(H)) ====>



     




NSN 75450-010152-8082 OPTIONAL FORM 348 (10/83)

Prescribed by GSA FAR (48 CFR)



SUPPLEMENTAL INVOICING INFORMATION


NOTE. - If desired, this order (or a copy thereof) may be used by the Contractor as the Contractor's invoice, instead of a separate invoice, provided the following statement, (signed and dated) is on (or attached to) the order: "Payment is requested in the amount of $____________ . No other invoice will be submitted." However, if the Contractor wishes to submit an invoice, the following information must be provided: contract number (if any), order number, item number(s), description of supplies or services, sizes, quantities, unit prices, and extended totals. Prepaid shipping costs will be indicated as a separate item on the invoice. Where shipping costs exceed $10 (except for parcel post), the billing must be supported by a bill of lading or receipt. When several orders are invoiced to an ordering activity during the same billing period, consolidated and periodic billings are encouraged.






RECEIVING REPORT


Quantity in the "Quantity Accepted" column on the face of this order has been: inspected, accepted, received by me and conforms to contract. Items listed below have been rejected for the reasons indicated.



SHIPMENT

NUMBER


PARTIAL




DATE RECEIVED

SIGNATURE OF AUTHORIZED U.S. GOV'T REP.


DATE

FINAL




TOTAL CONTAINERS

GROSS WEIGHT



RECEIVED AT

TITLE

REPORT OF REJECTIONS

ITEM NO.

SUPPLIES OR SERVICES

UNIT

QUANTITY

REJECTED


REASON FOR REJECTION





















































































































































































































































































































































































































































































































































































































































































OPTIONAL FORM 347 (Rev. 6/95) BACK


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