ATTACH.4-_Sample_DTI.doc

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Water, Drinking - Niger
Solicitation number
SPE303-16-Q-0001
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Attachment 4

THIS IS A SAMPLE OF A DELIVERY TICKET AND/OR INVOICE

Company__________________________

Address __________________________

Telephone# _____________________

Fax# _____________________

Date:_______________

Contract No/BPA: SPE303-16-A- _____ Date Delivered: __________________________ Delivery To: ___________________________ Delivery Ticket/ Invoice No: ________________

Item Number
Nomenclature
Quantity
Unit Price

Cases/Pkg

Delivered

Total Amount

0001
Water non carbonated, 1.5 liter

6 bottles/carton

0002
Water non-carbonated, 0.5 liter

12 bottles/carton

Total

For information/problems with Invoice contact: _________________________

Printed Name of Vendor Representative/Date

Printed Name Receiver/ Date

Signature of Vendor Representative/Date

Signature Receiver/ Date

File details come from the government source that posted it. Updated .