OF_347.pdf
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- Solicitation number
- ag-4568-s-12-0022
- Issued by
-
Department of Agriculture Forest Service
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Att 4 Sample Task Order
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Text version
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)
3. ORDER NO. 4. REQUISITION/REFERENCE NO.
5. ISSUING OFFICE (Address correspondence to)
6. SHIP TO:
a. NAME OF CONSIGNEE
b. STREET ADDRESS
c. CITY d. STATE e. ZIP CODE
f. SHIP VIA
8. TYPE OF ORDER
a. PURCHASE
REFERENCE YOUR:
7. TO:
a. NAME OF CONTRACTOR
b. COMPANY NAME
c. STREET ADDRESS
d. CITY e. STATE f. ZIP CODE
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.
17. SCHEDULE (See reverse for Rejections)
22.UNITED STATES OF
AMERICA BY (Signature)
23. NAME (Typed)
TITLE: CONTRACTING/ORDERING OFFICER
SEE BILLING
INSTRUCTIONS
ON
REVERSE
18. SHIPPING POINT 19. GROSS SHIPPING WEIGHT 20. INVOICE NO.
21. MAIL INVOICE TO:
a. NAME
b. STREET ADDRESS (or P.O. Box)
c. CITY d. STATE e. ZIP CODE
17(h) TOT.
(Cont.
pages)
17(i)
GRAND
TOTAL
OPTIONAL FORM 347 (REV. 5/2011)
Prescribed by GSA/FAR 48 CFR 53.213(f)
9. ACCOUNTING AND APPROPRIATION DATA 10. REQUISITIONING OFFICE
11. BUSINESS CLASSIFICATION (Check appropriate box(es))
a. SMALL
Please furnish the following on the terms and conditions specified on both sides of this order and on the attached sheet, if any, including delivery as indicated.
AUTHORIZED FOR LOCAL REPRODUCTION
PREVIOUS EDITION NOT USABLE
d. WOMEN-OWNED
h. ECONOMICALLY DISADVANTAGED WOMEN-OWNED
SMALL BUSINESS (EDWOSB)
12. F.O.B. POINT
13. PLACE OF
a. INSPECTION b. ACCEPTANCE
14. GOVERNMENT B/L NO. 15. DELIVER TO F.O.B. POINT ON
OR BEFORE (Date)
16. DISCOUNT TERMS
b. OTHER THAN SMALL c. DISADVANTAGED
g. WOMEN-OWNED SMALL BUSINESS (WOSB)
ELIGIBLE UNDER THE WOMEN-OWNED
SMALL BUSINESS PROGRAM
e. HUBZone
f. SERVICE-DISABLED
VETERAN-OWNED
ITEM NO.
(a)
SUPPLIES OR SERVICES
(b)
QUANTITY
ORDERED
(c)
UNIT
(d)
UNIT
PRICE
(e)
AMOUNT
(f)
QUANTITY
ACCEPTED
(g)
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