PAYMENT REQUEST FORM_Form Only.docx
DOCX document 13 KB Posted
- Attached to
- Supply-Filter Repair Kits
- Solicitation number
- N4523A25Q0006A001
About this file
This is a Payment Request Form template used for Government Purchase Card (GPC) transactions. The form is designed to capture key payment details including contract/delivery order number, contractor information (name, address, point of contact), shipment/service dates, and total sale amount. The second section is reserved for government use only and includes fields for authorization date, amount authorized, name/phone number, invoice number, and comments.
The form is associated with a solicitation (N4523A25Q0006A001) from the Department of the Navy Naval Supply Systems Command for Filter Repair Kits. The solicitation emphasizes that vendors must have the correct NAICS code listed in their SAM profile and must provide complete contact information with their submittal.
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Other files
| File | Type | Posted |
|---|---|---|
| 25Q0006 0001_Solicitation_Repair Kits_CONFORMED.pdf | ||
| VENDOR INFORMATION-Fill In.docx | DOCX document | |
| A5 42977074_ODS_Repair Kits.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 .