53.301-44a Standard Form 44a

INSTRUCTIONS

(This form is for official Government use only)

1. Filling in the Form

(a) All copies of the form must be legible. To insure legibility, indelible pencil or ball-point pen should be used. SELLER'S NAME AND ADDRESS MUST BE PRINTED.

(b) Items ordered will be individually listed. General descriptions such as "hardware" are not acceptable. Show discount terms.

(c) Enter project reference or other identifying description in space captioned "PURPOSE." Also, enter proper accounting information, if known.

2. Distributing Copies

Copy No. 1 – Give to seller for use as the invoice or as an attachment to his commercial invoice.

Copy No. 2 – Give to seller for use as a record of the order.

Copy No. 3 -

(1) On over the coounter transactions where delivery has been made, complete receiving report section and forware this copy to the proper administra live office.

(2) On other than completed over-the-counter transactions, forward this copy to location specified for delivery. (Upon delivery receiing report section is to be completed and this copy then forwarded to the proper administrative office.

Copy No. 4 – Retain in the book, unless otherwise instructed.

3. When Paying Cast at Time of Purchase

(a) Enter the amount of cash paid and obtain seller's signature in the space provided in the Seller section of Copy No. 1. If seller prefers to provide a commercial cash receipt, attach it to Copy No. 1 and check the "paid in cash" block at the bottom of the form.

(b) Distribution of copies when payment is by cash is the same as described above, except that Copy No. 1 is retained by Government representative when cash payment is made. Copy No. 1 is used thereafter in accordance with agency instructions pertaining to handlings receipts for cash payment.

U.S GOVERNMENT
PURCHASE ORDER-INVOICE-VOUCHER
DATE OF ORDER	ORDER NO.

PRINT NAME AND ADDRESS OF SELLER (Numbers, Street, City, and State)*

P
A
Y
E
E

FURNISH SUPPLIES OR SERVICES TC (Name and address)*

SUPPLIES OR SERVICES	QUANTITY	UNIT PRICE	AMOUNT

AGENCY NAME AND BILLING ADDRESS*

TOTAL

P
A
Y
O
R

DISCOUNT TERMS

………….%................ DAYS

DATE INVOICE RECEIVED

ORDERED BY (Signature and title)

PURPOSE AND ACCOUNTING DATA

PURCHASER – To sign below for over-the counter delivery of items

RECEIVED BY

TITLE	DATE
SELLER – Please read instructions on Copy 2
PAYMENT RECEIVED $............................	PAYMENT REQUESTED $.............................
NO FURTHER INVOICE NEED BE SUBMITTED
SELLER	DATE

BY……………………………………………………………………
(Signature)
I certify that this account is correct and proper for payment in the amount of	DIFFERENCES
$ ………………………………………….
	ACCOUNT VERIFIED.
	CORRECT FOR
………………………………………………………………………….
(Authorized certifying officer)	BY……………………………………………………………………

PAID BY	CASH	DATE PAID	VOUCHER NO.
OR……………………………………
(Check No.)
PLEASE INCLUDE ZIP CODE		1. SELLER'S INVOICE (See Instructions on Copy 2)	STANDARD FORM 44a (Rev. 10-83) PRESCRIBED BY GSA. FAR (48 CFR) 53.213(c)