Date of Order:

Order No.:

Name and Address of Seller (Number, Street, City, State, and Zip):

Furnish Supplies or Services to (Name and address):

Description of Supplies or Services

Quantity

Unit Price

Amount

DFI Office Billing Address:

Total

Discount Terms

______ _______ Days  ______ %

Date Invoice Received:

Ordered By (Signature and title):

DFI Account Designation and Purpose:

Purchaser

Received by

Title:

Date

Seller

Payment Received: $

Payment Requested: $

Seller Signature:

Date:

DFI Certification

I certify that this account is correct and proper for payment in the amount of $_______________.

Authorized Signature:

Title:

Date:

Differences:

Paid by Cash _______ or Check No. _____________

Date Paid:

Voucher No.

STATEMENT OF AGENT'S ACCOUNT

DFI ACCOUNT MANAGER’S OR DIVISION LEVEL AGENT’S NAME, ADDRESS, UNIT IDENTIFICATION NUMBER

DIVISION LEVEL AGENTAGENT'S OR FIELD PAYING AGENT’S NAME, GRADE, IDENTIFICATION, UNIT ADDRESS

TRANSACTIONS AFFECTING DIVISION LEVEL OR FIELD PAYING AGENT’S ACCOUNT

INCREASE

BEGINNING BALANCE

DECREASE

ENDING BALANCE

TRANSACTIONS

(received by Agent)

(In Agents's Account)

(Turned in by Agent)

(In Agent's Account)

A

b

C

D

E

1. BALANCE FORWARD

0.00

0.00

2. U.S. DOLLARS

3. FOREIGN CURRENCY

4. COLLECTIONS 

5. NEGOTIABLE INSTRUMENTS

   A. TREASURY CHECKS

6. PAID VOUCHERS

7. OTHER

8. TOTAL FUNDS IN HANDS OF AGENT OFFICER

0.00

0.00

STATEMENTS

DFI ACCOUNT MANAGER OR DIVISION LEVEL AGENT

DIVISION LEVEL AGENT OR FIELD PAYING AGENT

_ _ ON ADVANCE: I, AS AGENT, HAVE RECEIVED FUNDS AND/OR OTHER ITEMS AS INDICATED ABOVE. I HAVE ASSUMED RESPONSIBILITY THEREFOR.

   ___ ON ADVANCE:  I HAVE INTRUSTED FUNDS AND/OR OTHER ITEMS AS INDICATED IN THIS STATEMENT TO THE ABOVE NAMED AS MY AGENT

I WILL NOTIFY THE DFI ACCOUNT MANAGER OR THE DIVISION LEVEL AGENT IMMEDIATELY UPON DISCOVERY OF ANY LOSS OR SHORTAGE

AND I HAVE RECEIVED AND UNDERSTAND WRITTEN INSTRUCTIONS

CONCERNING MY DUTIES AND RESPONSIBILITIES AS AN AGENT

DATE / SIGNATURE OF DFI ACCOUNT MANAGER OR DIVISION LEVEL AGENT

DATE / SIGNATURE OF DIVISION LEVEL AGENT OR FIELD PAYING AGENT

___ON RETURN:  I HAVE RECEIVED FUNDS AND/OR OTHER ITEMS AS INDICATED ON THIS STATEMENT FROM THE ABOVE AGENT

____ON RETURN: THE ABOVE STATEMENT OF ACCOUNT IS CORRECT

DATE / SIGNATURE OF DFI ACCOUNT MANAGER OR DIVISION LEVEL AGENT

DATE / SIGNATURE OF DIVISION LEVEL AGENT OR FIELD PAYING AGENT

DFI FORM 1081, DEC 2003

SIGNATURE CARD

1. Name (Type or print)

2. Pay Grade

3. Date

4. Official Address

5. Signature

6. Type of Document or Purpose for which authorized

The authorized individual’s signature is shown above

7. name of commanding/appointing officer (Type or print)

8. pay grade

9. signature of commanding/appointing officer