Attachment 31-Print Request Form - Blank FLETC Form-142-00-01.pdf
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- Training Support Services
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- 70LART25RPFB00006
About this file
This is a blank publishing services requisition form (Form-142-00-01) used by the Department of Homeland Security Federal Law Enforcement Training Centers (FLETC) Publishing Services Branch located in Glynco, GA. The form is used to request various publishing and media services.
The form captures details for three main service categories: Digital Print/Duplication (including black/white and color reproduction options), Bindery services (including collating, stapling, drilling, laminating), and CD/DVD/BD/USB duplication services. It includes fields for customer contact information, delivery location options (Glynco, Charleston, Artesia, or Cheltenham), quantity requirements, funding codes, and special instructions. The form also contains sections for internal use by the publishing services staff to track production steps, costs, and accounting information. A signature is required to verify that submitted materials do not violate copyright or trademark laws.
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Text version
DEPARTMENT OF HOMELAND SECURITY
FEDERAL LAW ENFORCEMENT TRAINING CENTERS
PUBLISHING SERVICES REQUISITION
FLETC/Publishing Services Branch Bldg. 680, Glynco GA.
Contact Information Organization: Bldg./Rm. Number:
Customer Name: Phone Number:
Backup Contact: Phone Number:
Course Title/Acronym:
Funding Type: Funding Code:
Agreement Number:
Publication Title: REV. Date:
PUB PRINT
REQ. NO:
Agency Trkng#:
Date Received:
Date Required:
QUANTITY:
Delivery: Glynco Charleston
Artesia Cheltenham Other
Call for Pickup Warehouse
Distribution
Product Classification (Check all that apply) Digital Print/Duplication
Black/White Reproduction Color Reproduction Face Only Head to Head Head to Foot
Bindery Collate Acetate Staple Fold Saddle Stitch Slip Sheets Drill Rubber Band Laminate Trim
Tape Bind: Trim Size:
Coil Bind: Text Paper:
Pad: Cover Paper:
Indicate Which Covers Print 1 2 3 4 Additional Details/Special Instructions:
CD/DVD/BD/USB Duplication
CD DVD BD USB
Duplication Only Bookmarking/Linking Authoring Label Only Document Scanning
Staff Assigned:
1. Agency/Title
2. Approved Logos 3. JOB
NUMBER/DATE
4. FOUO/LES Verbiage
Area 1:
Area 2:
Area 3: PUB USE ONLY
Area 4:
PUB USE ONLY: (initial & date completed portion) Scan: Print:
Pre-Press: Binding:
Proof: Packaging:
Accounting Information (PUB USE ONLY)
Number of Pages:
Number of Sheets:
Number of Cover Stock:
Number of Tabs:
COST
B/W: BD:
COLOR: USB:
CD:
DVD:
TOTAL:
Print Center File Original GPO
PUB USE ONLY: (initial & date completed portion)
Scan to File:
Linking/Bookmarking:
Authoring:
Duplicated/Printed Label:
Boxed/Packaged into Shells:
Agency/Division Approval Signature: Date:
If materials are submitted with this request, this signature verifies that materials are not in violation of any copyright or trademark laws.
FLETC Form-142-00-01 (10/19) Page 1 of 1
11.0.1.20130830.1.901444
PUBLISHING SERVICES REQUISITION
DHS Form FTC SSD-PUB-8
DEPARTMENT OF HOMELAND SECURITYFEDERAL LAW ENFORCEMENT TRAINING CENTERS
PUBLISHING SERVICES REQUISITION
FLETC/Publishing Services Branch Bldg. 680, Glynco GA.
Contact Information Organization:
Bldg./Rm. Number:
Customer Name:
Phone Number:
Backup Contact:
Phone Number:
Course Title/Acronym:
Funding Type:
Funding Code:
Agreement Number:
Publication Title:
REV. Date:
PUB PRINT REQ. NO:
Agency Trkng#:
Date Received:
Date Required:
QUANTITY:
Delivery:
Glynco Charleston Artesia Cheltenham Other Call for Pickup Warehouse Distribution Product Classification (Check all that apply) Digital Print/Duplication Black/White Reproduction Color Reproduction Face Only Head to Head Head to Foot Bindery Collate Acetate Staple Fold Saddle Stitch Slip Sheets Drill Rubber Band Laminate Trim Tape Bind:
Trim Size:
Coil Bind:
Text Paper:
Pad:
Cover Paper:
Indicate Which Covers Print Additional Details/Special Instructions:
CD/DVD/BD/USB Duplication
CD
DVD
BD
USB
Duplication Only Bookmarking/Linking Authoring Label Only Document Scanning Staff Assigned:
1. Agency/Title
2. Approved Logos
3. JOB NUMBER/DATE
4. FOUO/LES Verbiage Area 1:
Area 2:
Area 3:
PUB USE ONLY
Area 4:
PUB USE ONLY: (initial & date completed portion) Scan:
Print:
Pre-Press:
Binding:
Proof:
Packaging:
Accounting Information (PUB USE ONLY) Number of Pages:
Number of Sheets:
Number of Cover Stock:
Number of Tabs:
COST
B/W:
BD:
COLOR:
USB:
CD:
DVD:
TOTAL:
Print Center File Original
GPO
PUB USE ONLY: (initial & date completed portion) Scan to File:
Linking/Bookmarking:
Authoring:
Duplicated/Printed Label:
Boxed/Packaged into Shells:
Agency/Division Approval Signature:
Date:
If materials are submitted with this request, this signature verifies that materials are not in violation of any copyright or trademark laws.
FLETC Form-142-00-01 (10/19)
| Organization.: |
| Building / Room Number.: |
| Customer Name.: |
| Phone Number. Enter 10 digit telephone number including area code.: |
| Backup Contact.: |
| Course Title/Acronym: |
| Funding Type.: |
| Funding Code: |
| Agreement Number: |
| Publication Title.: |
| Date Required. Enter 2 digit month, 2 digit day and 4 digit year.: |
| Publishing Print Requisition Number.: |
| Agency Tracking number.: |
| Date Received. Enter 2 digit month, 2 digit day and 4 digit year.: |
| Quantity.: |
| Delivery. Other.: 0 |
| Call for Pickup check box: 0 |
| Distribution check box: 0 |
| Document Scanning check box.: 0 |
| Document Scanning check box.: 0 |
| Document Scanning check box.: 0 |
| Document Scanning check box.: 0 |
| Document Scanning check box.: 0 |
| Document Scanning check box.: 0 |
| Document Scanning check box.: 0 |
| Document Scanning check box.: 0 |
| Document Scanning check box.: 0 |
| Document Scanning check box.: 0 |
| Document Scanning check box.: 0 |
| Document Scanning check box.: 0 |
| Document Scanning check box.: 0 |
| Document Scanning check box.: 0 |
| Document Scanning check box.: 0 |
| Document Scanning check box.: 0 |
| Document Scanning check box.: 0 |
| Document Scanning check box.: 0 |
| Document Scanning check box.: 0 |
| Document Scanning check box.: 0 |
| Document Scanning check box.: 0 |
| Document Scanning check box.: 0 |
| Laminate check box: 0 |
| Tape Bind.: |
| Trim Size.: |
| Coil Bind.: |
| Text Paper.: |
| Pad.: |
| Cover Paper.: |
| Additional Details / Special Instructions.: |
| B D check box. : 0 |
| USB check box: 0 |
| Label only check box.: 0 |
| Staff Assigned: |
| Area 4.: |
| Scan to File.: |
| Print.: |
| Pre-Press.: |
| Binding.: |
| Proof.: |
| Packaging.: |
| Number of Pages.: |
| Number of Sheets.: |
| Number of Cover Stock.: |
| Number of Tabs.: |
| Cost. Black and White.: |
| B D.: |
| Color.: |
| USB: |
| C D.: |
| Other Cost 3.: |
| other cost: |
| D V D.: |
| B D.: |
| Total: |
| Print Center.: 0 |
| File Original.: 0 |
| G P O.: 0 |
| Linking / Bookmarking.: |
| Authoring.: |
| Duplicated / Printed Label.: |
| Boxed / Packaged into Shells.: |
| Agency/Division Approval Signature: |
| Date of Signature. Enter 2 digit month, 2 digit day and 4 digit year.: |
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