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15F06720F0000659 Page 2 of 10 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. SHIPMENTPARTIAL DATE RECEIVED SIGNATURE OF AUTHORIZED U.S. GOV'T REP. DATE NUMBER FINAL TOTAL CONTAINERS GROSS WEIGHT RECEIVED AT TITLE REPORT OF REJECTIONS TEMNO ..SUPPLIESOR'SERVICES UNITS QUANTITY REJEOTED REASONFORREJECTION OPTIONALFORM347 (REV.2/2012)BACK