W911SA-23-Q-3046 - Attachment 4 - Pick-up and Delivery Ticket.docx

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Laundry Services for Fort McCoy RSO
Solicitation number
W911SA-23-Q-3046
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Religious Support Office (RSO) Laundry Request / Delivery Ticket

Fort McCoy ChapelContract #:
2675 South F StreetTask Order #:

Fort McCoy, WI 54656

Requested Pick-Up Date
Requested Return Delivery Date

YYYYMMDD:

YYYYMMDD:

CLIN
Item
Quantity Requested
Quantity Picked Up
Quantity Returned
0001
Linen tablecloths (90” & 30” rnd)
0002
Liturgical Robes/Chasubles
0003
Rectangular Altar Cloth
0004
Altar cloths (Large)
0005
Altar cloths (Medium)
0006
Altar cloths (Small)
0007
White Pullover top
0008
Dish towels
0009
Dish cloths
0010
White Pall slipcovers

Pick-Up Service

Date (YYYYMMDD):

Fort McCoy Chapel POC
Band Box POC

Printed Name Printed Name

Signature Signature

Return Delivery Service

Date (YYYYMMDD):

Fort McCoy Chapel POC
Band Box POC

Printed Name Printed Name

Signature Signature

Issues (Incorrect quantity picked up or returned, early or late, damages, damp, stained, dirty, etc., or N/A):

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