Attachment 4 GSA Delivery Order.pdf

ORDER FOR SUPPLIES

OR SERVICES

1. GSA

USE

ONLY

2. DATE OF ORDER

IMPORTANT - A copy of this order or the information specified in item 10 below MUST accompany shipment.

3. ORDER NUMBER

4. FROM

5. INSPECTION/ACCEPTANCE

7. F O B

6. MODIFICA-

TION NO

8. GBL NUMBERADMINISTRATION BY

9A. VENDOR WILL 9B. BY

10. SHIP TO/REQUIRED MARKING

MARK

FOR

TRNSP

CNTRL

NO TAC:

(INCLUDE REQUISITION NUMBER(S) AS SHOWN IN ITEM 12)

12. REQUISITION NO, ITEM/STOCK NO. AND DESCRIPTION

16. DISCOUNT TERMS

19. AFTER SHIPMENT, SUBMIT INVOICE(S)

ELECTRONICALLY IN ACCORDANCE WITH TRADING

PARTNER AGREEMENT, OR MAIL TO:

GSA ACCOUNTS PAYABLE BRANCH

KANSAS CITY, MO 64141

FOR PAYMENT INQUIRY, CALL THE CHIEF, ACCOUNTS

PAYABLE BRANCH:

20. FOR INFORMATION (OTHER THAN PAYMENT

INQUIRES) CALL

17. QUANTITY VARIATION ALLOWED

21. SIGNATURE (CONTRACTING/PURCHASING OFFICER)

22. DPAS

RATING

23. MSD'S

REQ'D.

25. PAGES

OF

24. POP

18. TOTAL(S)

CONDITIONS: YOU MUST ABIDE BY THE TERMS AND CONDITIONS REFERENCED IN THE

CONTRACT NUMBER SHOWN ABOVE IN ITEM 11.

CONTRACT NUMBER

(CONSIGNEE ) 11. TO CONTRACTOR

13.

QUANTITY

14.

UNIT

15. COST

A. UNIT PRICE B. AMOUNT

(Remittance address differs)

(days after delivery)

GENERAL SERVICES ADMINISTRATION

GSA FORM 3186 (Rev 7/94)GENERAL SERVICES ADMINISTRATION

B.A. ABOVE

OFFICE

SHIPDELIVER

RDDPROJ. PRI

SEE NOTE IN ITEM 12OR SOONER

C. ACCEPT-

ANCE

BY

A. DESTI-

NATION

B. ORIGIN

BY

REGION

D. TAILGATE

DELIVERY

A. DESTINATION B. ORIGIN

C. INSIDE

DELIVERY