Attachment 1 - OF-347.rtf

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 NO.

4. REQUISITION/REFERENCE NO.

b. STREET ADDRESS

5. ISSUING OFFICE (Address correspondence to)

c. CITY

d. STATE

e. ZIP CODE

7. TO:

f. SHIP VIA

a. NAME OF CONTRACTOR

8. TYPE OF ORDER

b. COMPANY NAME [ ] a. PURCHASE [ ] b. DELIVERY -- Except

REF YOUR: ________________

for billing instructions on the reverse, this

c. STREET ADDRESS Please furnish the following on the terms delivery order is subject to instructions and conditions specified on both sides of contained on this side only of this form

d. CITY

e. STATE

f. ZIP CODE this order and on the attached sheet, if and is issued subject to the terms and any, including delivery as indicated.

conditions of the above-numbered contract.

9. ACCOUNTING AND APPROPRIATION DATA

10. REQUISITIONING OFFICE

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

a. SMALL b. OTHER THAN SMALL c. DISADVANTAGED d. WOMEN-OWNED

12. F.O.B. POINT

14. GOVERNMENT B/L NO.

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)

18. SHIPPING POINT

19. GROSS SHIPPING WEIGHT

20. INVOICE NO.

17(h) TOT.

SEE

21. MAIL INVOICE TO:

(Cont.

BILLING

a. NAME pages)

INSTRUCTIONS

ON

b. STREET ADDRESS (or P.O. Box)

REVERSE

17(i)

c. CITY

d. STATE

e. ZIP CODE

GRAND

TOTAL

22. UNITED STATES OF

AMERICA BY (Signature)

23. NAME (Typed)

TITLE: CONTRACTING/ORDERING OFFICER

SUPPLEMENTAL INVOICING INFORMATION

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 service, 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 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

PARTIAL

DATE RECEIVED

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

DATE

NUMBER

FINAL

TOTAL CONTAINERS

GROSS WEIGHT

RECEIVED AT

TITLE

REPORT OF REJECTIONS

ITEM NO.

SUPPLIES OR SERVICES

UNIT

QUANTITY

REJECTED

REASON FOR REJECTION

Computer Generated OPTIONAL FORM 347 (REV. 6/95) BACK