Exhibit 9 - OF347 - Order Supplies or Services.pdf

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Untitled

Printing C:\\FORMFLOW\\FORMS\\OF\\O347_2.FRP BarbMWilliams D:20050315124712- 05'00' D:20050331132350- 05'00'

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. 4/2006)

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

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

e. HUBZone

f. EMERGING SMALL

BUSINESS

g. SERVICE-

DISABLED

VETERAN-

OWNED

ITEM NO.

(a)

SUPPLIES OR SERVICES

(b)

QUANTITY

ORDERED

(c)

UNIT

(d)

UNIT

PRICE

(e)

AMOUNT

(f)

QUANTITY

ACCEPTED

(g)

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

SHIPMENT

NUMBER

PARTIAL

FINAL

DATE RECEIVED

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

DATE

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. 4/2006) BACK

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.