| |
and date sent.
Q12-1. Who provides MPOs with the necessary
supplies, publications, and equipment to
operate?
Q12-2. What agency provides MPOs with equipment
such as safes, calculators, office furniture,
and copying machines?
Q12-3.
What agency(ies) provide(s) MPOs with
common supply items such as pens, and
writing paper?
12-7
IMPORTANT: Read instructions on reverse carefully, before completing this form.
2. BILLED OFFICE CODE (6 digits)
NOTE:
Maximum of 35 characters per block for Agency Name, Office Name,
Contact Name, Street Address, and City.
Punctuation and spaces count as
characters.
1. ACTIVITY ADDRESS CODE (6 digits)
a. AGENCY NAME
B. OFFICE NAME
c. STREET ADDRESS
d. CITY
e. STATE
f. ZIP CODE
a. CONTACT NAME
b. AGENCY NAME
c. OFFICE NAME
d. STREET ADDRESS
e. CITY
4. BILL TO: (Complete only if different from item 3.)
3. SHIP TO:
(Catalogs sent to this address)
5. ACCESS CODE
(3 to 5 digits)
6. NAME, OFFICE, ETC., PRINTED ON SHIPPING LABEL (Optional)
(Maximum 28 characters. Punctuation and spaces count as characters.)
7. FUND CODE
(2 digits)
8. AGENCY INTERNAL CODE
(6 digits)
f. STATE
g. ZIP CODE
LINE
NO.
1
2
3
4
5
6
7
8
9
9. COST ELEMENT* (3 digits)
10. FUNCTION CODE* (3 digits)
11. VDC* (2 digits)
12. PURCHASE CARD USAGE ONLY
CHECK HERE IF APPLICABLE
13. TYPE OF APPLICATION
NEW
ADDRESS CHANGE
14a. SIGNATURE OF APPROVING OFFICER
14b. TYPED NAME OF APPROVING OFFICER
14c. TITLE OF APPROVING OFFICER
14d. TELEPHONE
AREA CODE NUMBER
14e. DATE
The eligibility of the above-named activity to patronize the GSA Customer Supply Center has been checked and the application
approved or disapproved, as indicated in Item 20a. below.
15. AGENCY BUREAU CODE (4
digits)
16. STATE CODE (2 digits)
17. CITY CODE (4 digits)
18. CONTRACTOR
19. EXPIRATION DATE (6 digits)
22a. SIGNATURE OF GSA APPROVING OFFICIAL
22b. TYPED NAME OF GSA APPROVING OFFICIAL
22c. TITLE
22d. DATE
DATE
CATALOG AND CUSTOMER
APPLICATION COPY MAILED
GSA
3525
FORM
(REV. 8-95)
Prescribed by FSS P2901.14
21. TYPE OF CUSTOMER AGENCY
CIVILIAN
AGENCY
MILITARY
CONTRACTOR
CONGRESSIONAL
(If Contractor/Congres-
sional, give expiration
date)
20a. ACTION
APPROVED
DISAPPROVED
RECEIVED
APP./DISAPP.
20b. DATES
ADDRESS LOADED
DATE
CLERK INITIALS
SECTION II - ACTION (For GSA use only)
SECTION I - APPLICATION
APPLICATION FOR CUSTOMER SUPPLY CENTER SERVICES AND ADDRESS CHANGE
GENERAL SERVICES ADMINISTRATION
*(GSA ONLY)
PCf12002
Figure 12-2.
An example of an Application For Customer Supply Center Services And Address Change.
|
