W911SA-21-Q-3064 MS PPC - Attachment 5 - Service Ticket.docx
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- W911SA-21-Q-3064
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Service Ticket Date of Service: ________________________ Receipt #: _______________ Contract Number: _____________________________________________________________ Location of Service: (Shop Name) _________________________________________________ Address of Service: (Shop Address) _______________________________________________ Company Name: _____________________________________________________________ Company Address: ____________________________________________________________
Contact Phone: ______________________________
Delivery Employee: _____________________________ Phone: ______________________ Clean Uniform Sets Delivered
Dirty Uniform Sets Picked Up
| CLIN |
| Items Description |
| Total Number |
| CLIN |
| Items Description |
| Total Number |
| ___001 |
| Shop Uniforms Sets |
| ___001 |
| Shop Uniforms Sets |
| ___002 |
| Office Uniforms Sets |
| ___002 |
| Office Uniforms Sets |
| ___003 |
| Jackets Each |
| ___ 003 |
| Jackets Each |
Additional Comments:
Signatures Delivery Employee: _______________________________________ Date: ______________ Authorized Government Employee: ___________________________ Date: _____________
File details come from the government source that posted it. Updated .