DFI-Designated Financial Forms

APPENDIX A DFI-Designated Financial Forms PURCHASE ORDER – 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 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 DFI FORM 577, DEC 2003