AA_Form.pdf

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DLA

10.0.2.20120224.1.869952 Date of Filing:

VLO#

Bill of Lading #:

Carrier:

Driver POC info (if available) Name:

Accessorial Code Accessorial Name Comments that support request:

Denied - Printed Name:

Approved - Printed Name:

Reason for denial:

Date:

Accessorial Record Form Effective: XX/XX/XX Date of Occurrence:

Phone Number or Email:

Accessorial Services shall be authorized in accordance with the Military Freight Traffic Uniform Rules Publication or Defence Transportation Regulations Approved accessorial rates are found in each carrier's tender. Charges not specified must be approved in accordance with the above references.

Detailed explanations and source documentation requirements can be found in MFTURP.

This form is intended for internal record-keeping at DLA Distribution Centers. There is no regulatory requirement that this form be included for payment.

Transportation Protective Services are not included on this form. Any protective services with the exception of DEL shall be requested in advance.

Expedited Services are not included on this form. Any expedited pick up or delivery services shall be requested in advance.

Required Documentation

Additional Documentation Required: Gov't docs validating start and end time (ex:BOL/gate pass with times)

Additional Documentation Required: Gov't signed BOL w/above info, TO justification email (if applicable), detailed explanation in Comments section

Release Date/Time:

Accessorial Name_Row_1: Arrive Date/Time:

Depart Time:

DEP Hours:

DEP Location:

Accessorial Name_Row_1: Authorized Gov't Representative:

Diverted From (Address):

Diverted To (Address):

DTOD Miles (if applicable):

Accessorial Name_Row_1: Name of person certifying service:

Phone # or Email:

# of Trailers moved: