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APPENDIX A

DFI-Designated Financial Forms


PURCHASE ORDER Ė INVOICE - VOUCHER

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.

DFI FORM 44, DEC 2003


 

STATEMENT OF AGENT'S ACCOUNT

DFI ACCOUNT MANAGERíS OR DIVISION LEVEL AGENTíS NAME, ADDRESS, UNIT IDENTIFICATION NUMBER

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TRANSACTIONS AFFECTING DIVISION LEVEL OR FIELD PAYING AGENTíS 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 individualís signature is shown above

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

8. pay grade

9. signature of commanding/appointing officer

DFI FORM 577, DEC 2003


 

 

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