ORDER FOR SUPPLIES OR SERVICES

PAGE    OF    PAGES

IMPORTANT: Mark all packages and papers with contract and/or order numbers.

1. DATE OF ORDER

2. CONTRACT NO. (If any)

6. SHIP TO:

a. NAME OF CONSIGNEE

3. ORDER NO.

4. REQUISITION/REFERENCE NO.

b. STREET ADDRESS

5. ISSUING OFFICE (Address correspondence to)

c. CITY

d. STATE

e. ZIP CODE

7. TO:

f. SHIP VIA

a. NAME OF CONTRACTOR

8. TYPE OF ORDER

b. COMPANY NAME

a. PURCHASE REFERENCE YOUR: _________________ Please furnish the following on the terms and conditions specified on both sides of this order and on the attached sheet, if any, including delivery as indicated.

b. DELIVERY -- Except for billing instructions on the reverse, this delivery order is subject to instructions contained on this side only of this form and is issued subject to the terms and  conditions of the above-numbered

9. ACCOUNTING AND APPROPRIATION DATA

10. REQUISITIONING OFFICE

11. BUSINESS CLASSIFICATION (Check appropriate box(es))

12. F.O.B. POINT

a. SMALL

b. OTHER THAN SMALL

c. DISADVANTAGED

g. SERVICE-DISABLED VETERAN- OWNED

d. WOMEN-OWNED

e. HUBZone

f. EMERGING SMALL BUSINESS

13. PLACE OF

14. GOVERNMENT B/L NO.

15. DELIVER TO F.O.B. POINT ON OR BEFORE (Date)

16. DISCOUNT TERMS

a. INSPECTION

b. ACCEPTANCE

17. SCHEDULE (See reverse for Rejections)

ITEM NO.
(a)

SUPPLIES OR SERVICES
(b)

QUANTITY ORDERED
(c)

UNIT
(d)

UNIT PRICE
(e)

AMOUNT
(f)

QUANTITY ACCEPTED
(g)

18. SHIPPING POINT

19. GROSS SHIPPING WEIGHT

20. INVOICE NO.

SEE BILLING

21. MAIL INVOICE TO:

17(h) TOT.
(Cont. pages)

INSTRUCTIONS

a. NAME

ON

b. STREET ADDRESS (or P.O. Box)

REVERSE

c. CITY

d. STATE

e. ZIP CODE

17(i)
GRAND
TOTAL

22. UNITED STATES OF
AMERICA BY (Signature)

23. NAME (Typed)

TITLE: CONTRACTING/ORDERING OFFICER

SUPPLEMENTAL INVOICING INFORMATION

If desired, this order (or a copy thereof) may be used by the Contractor as the Contractor's invoice, instead of a separate invoice, provided the following statement, (signed and dated) is on (or attached to) the order:   "Payment is requested in the amount of $ __________________. No other invoice will be submitted." However, if the Contractor wishes to submit an invoice, the following information must be provided: contract number (if any), order number, item number(s), description of supplies or service, sizes, quantities, unit prices, and extended totals. Prepaid shipping costs will be indicated as a separate item on the invoice. Where shipping costs exceed $10 (except for parcel post), the billing must be supported by a bill of lading or receipt. When several orders are invoiced to an ordering activity during the same billing period, consolidated periodic billings are encouraged.

RECEIVING REPORT

Quantity in the "Quantity Accepted" column on the face of this order has been:

inspected,

accepted,

received by me

and conforms to contract. Items listed below have been rejected for the reasons indicated.

SHIPMENT

PARTIAL

DATE RECEIVED

SIGNATURE OF AUTHORIZED U.S. GOV'T REP.

DATE

NUMBER

FINAL

TOTAL CONTAINERS

GROSS WEIGHT

RECEIVED AT

TITLE

REPORT OF REJECTIONS

ITEM NO.

SUPPLIES OR SERVICES

UNIT

QUANTITY REJECTED

REASON FOR REJECTION

AUTHORIZED FOR LOCAL REPRODUCTION
PREVIOUS EDITION NOT USABLE

OPTIONAL FORM 347 (REV. 4/2006)
Prescribed by GSA/FAR 48 CFR 53.213(f)