PAYMENT REQUEST FORM_Form Only.docx
DOCX document 13 KB Posted
- Attached to
- Valve Plugs
- Solicitation number
- 25Q4018A
About this file
This is a Payment Request Form template for government purchase card transactions. The form is designed to capture key payment details including contract/delivery order number, contractor information (name, address, point of contact), shipment/service date, and total sale amount. The second section of the form is reserved for government use only and includes fields for authorization date, amount authorized, name/phone number, invoice number, initials, and comments.
This form template relates to a Navy solicitation (25Q4018A) for Valve Plugs issued by the Naval Supply Systems Command. While the payment form itself is a standard template without specific pricing or payment terms, it would be used to process payments for the valve plugs procurement once awarded.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 4309V000_ODS_Valve Plugs.pdf | ||
| VENDOR INFORMATION-Fill In.docx | DOCX document | |
| 25Q4018 A001_Solicitation_Valve Plugs_CONFORMED_1.28.2025.pdf |
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Text version
PAYMENT REQUEST FORM - GOVERNMENT PURCHASE CARD (MAY 17, 2017)
------------------------------------------------------PROFORMA INVOICE-----------------------------------------------------
Contract #/Delivery Order #: _________________________________________
Date: ____________________
Contractor Name: _______________________________________________
Address: ______________________________________________________
Point of Contact and Title: _________________________________________
Phone and fax number: _________________________________
E-Mail: ___________________________
Shipment or service date: __________________________________________
Total amount of sale: ______________________________________________
--------------------------------------------GPC AUTHORIZATION----------------------------------------- (For Government use only)
Date: ____________________________
Amount Authorized: _______________________
Name/Phone Number: ______________________________________________
Invoice Number: ________________________________________________
Initials: ________
Comments: ___________________________________________________
File details come from the government source that posted it. Updated .