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Get Dd Form 1155

CHECK NUMBER 35. BILL OF LADING NO. AT 38. RECEIVED BY Print DD FORM 1155 DEC 2001 39. DATE RECEIVED 40. PAGE 1 OF ORDER FOR SUPPLIES OR SERVICES 1. CONTRACT/PURCH ORDER/AGREEMENT NO. 3. DATE OF ORDER/CALL YYYYMMMDD 2. DELIVERY ORDER/CALL NO. CODE 6. ISSUED BY 4. REQUISITION/PURCH REQUEST NO. 7. ADMINISTERED BY If other than 6 5. PRIORITY 8. DELIVERY FOB DESTINATION OTHER See Schedule if other 9. CONTRACTOR 10. DELIVER TO FOB POINT BY Date FACILITY 11. X IF BUSINESS IS SMALL SMALL DISADVANTAGED 12. DISCOUNT TERMS NAME AND ADDRESS WOMEN-OWNED 13. MAIL INVOICES TO THE ADDRESS IN BLOCK 14. SHIP TO TYPE OF ORDER 15. PAYMENT WILL BE MADE BY DELIVERY/ CALL PURCHASE MARK ALL PACKAGES AND PAPERS WITH IDENTIFICATION NUMBERS IN BLOCKS 1 AND 2. This delivery order/call is issued on another Government agency or in accordance with and subject to terms and conditions of above numbered contract. Reference your furnish the following on terms specified herein* ACCEPTANCE* THE CONTRACTOR HEREBY ACCEPTS THE OFFER REPRESENTED BY THE NUMBERED PURCHASE ORDER AS IT MAY PREVIOUSLY HAVE BEEN OR IS NOW MODIFIED SUBJECT TO ALL OF THE TERMS AND CONDITIONS SET FORTH AND AGREES TO PERFORM THE SAME* NAME OF CONTRACTOR SIGNATURE TYPED NAME AND TITLE DATE SIGNED If this box is marked supplier must sign Acceptance and return the following number of copies 17. ACCOUNTING AND APPROPRIATION DATA/LOCAL USE 18. ITEM NO. 20. QUANTITY ORDERED/ ACCEPTED 19. SCHEDULE OF SUPPLIES/SERVICES UNIT 22. UNIT PRICE 23. AMOUNT 24. UNITED STATES OF AMERICA If quantity accepted by the Government is same as quantity ordered indicate by X. If different enter actual quantity accepted below quantity ordered and encircle. BY 25. TOTAL CONTRACTING/ORDERING OFFICER DIFFERENCES 27a* QUANTITY IN COLUMN 20 HAS BEEN ACCEPTED AND CONFORMS TO INSPECTED RECEIVED THE CONTRACT EXCEPT AS NOTED b. SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE c* DATE d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT REPRESENTATIVE 28. SHIP. NO. 29. D. O. VOUCHER NO. 30. INITIALS 32. PAID BY 33. AMOUNT VERIFIED CORRECT FOR PARTIAL f* TELEPHONE NUMBER g. E-MAIL ADDRESS FINAL 31. PAYMENT 36. I CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT. COMPLETE b. SIGNATURE AND TITLE OF CERTIFYING OFFICER 34. TOTAL CONTAINERS 41. S/R ACCOUNT NUMBER PREVIOUS EDITION IS OBSOLETE* 42. S/R VOUCHER NO. Adobe Professional 8. PAGE 1 OF ORDER FOR SUPPLIES OR SERVICES 1. CONTRACT/PURCH ORDER/AGREEMENT NO. 3. DATE OF ORDER/CALL YYYYMMMDD 2. DELIVERY ORDER/CALL NO. CODE 6. ISSUED BY 4. REQUISITION/PURCH REQUEST NO. 7. ADMINISTERED BY If other than 6 5. DELIVERY ORDER/CALL NO. CODE 6. ISSUED BY 4. REQUISITION/PURCH REQUEST NO. 7. ADMINISTERED BY If other than 6 5. PRIORITY 8. DELIVERY FOB DESTINATION OTHER See Schedule if other 9. CONTRACTOR 10. DELIVER TO FOB POINT BY Date FACILITY 11. PRIORITY 8. DELIVERY FOB DESTINATION OTHER See Schedule if other 9. CONTRACTOR 10. DELIVER TO FOB POINT BY Date FACILITY 11. X IF BUSINESS IS SMALL SMALL DISADVANTAGED 12. DISCOUNT TERMS NAME AND ADDRESS WOMEN-OWNED 13. MAIL INVOICES TO THE ADDRESS IN BLOCK 14.

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