PAGE
OF
PAGES
ORDER FOR SUPPLIES OR SERVICES
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
b. DELIVERY -- Except for billing
a. PURCHASE
instructions on the reverse, this delivery
c. STREET ADDRESS
REFERENCE YOUR:
order is subject to instructions contained
on this side only of this form and is
Please furnish the following on the terms and
issued
subject
to
the
terms
and
conditions specified on both sides of this
d. CITY
e. STATE f. ZIP CODE
conditions
of
the
above-numbered
order and on the attached sheet, if any,
contract.
including delivery as indicated.
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
d. WOMEN-OWNED
e. HUBZone
g. WOMEN-OWNED SMALL BUSINESS (WOSB)
f. SERVICE-DISABLED
h. EDWOSB
ELIGIBLE UNDER THE WOSB PROGRAM
VETERAN-OWNED
15. DELIVER TO F.O.B. POINT ON
14. GOVERNMENT B/L NO.
16. DISCOUNT TERMS
13. PLACE OF
OR BEFORE (Date)
a. INSPECTION
b. ACCEPTANCE
17. SCHEDULE (See reverse for Rejections)
QUANTITY
UNIT
QUANTITY
ITEM NO.
SUPPLIES OR SERVICES
ORDERED
UNIT
PRICE
AMOUNT
ACCEPTED
(a)
(b)
(c)
(d)
(e)
(f)
(g)
18. SHIPPING POINT
19. GROSS SHIPPING WEIGHT
20. INVOICE NO.
17(h) TOT.
21. MAIL INVOICE TO:
(Cont.
SEE BILLING
a. NAME
pages)
INSTRUCTIONS
ON
b. STREET ADDRESS (or P.O. Box)
REVERSE
17(i)
$
c. CITY
d. STATE e. ZIP CODE
GRAND
TOTAL
23. NAME (Typed)
22.UNITED STATES OF
AMERICA BY (Signature)
TITLE: CONTRACTING/ORDERING OFFICER
OPTIONAL FORM 347
AUTHORIZED FOR LOCAL REPRODUCTION
(REV. 2/2012)
PREVIOUS EDITION NOT USABLE
Prescribed by GSA/FAR 48 CFR 53.213(f)