Last updated: 1/8/2009
Requisition For Supplies Equipment Forms Publications And Procurement {HUD-10.4}
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Description
Requisition for Supplies, Equipment, Forms, Publications and Procurement Services Shaded Areas for Services Use Only Supply Source: U.S. Department of Housing and Urban Development 2. Posted By: 4. Processed By: 3. Control No: 5. Estimated Delivery Date: Fed. Supply Schedule Fed Strip Other Govt. Agency Group No: Local Agency Acct. 8. Mail Invoice to: Open Market GSA FSS Commodity 6. GSA Contract No: 7. HUD Purchase Order No: 9. Vendor: 10. Appropriation Code: 12. Organization Code: 15. Description 11. Sub-Object: 13. Amount Reserved: 14. Authorizing Funds Control Official: (signature & date) 16. Quantity 17. Unit of Issue 18. Est. Price Per Unit 19. Est. Total Cost 20. Action Code Total 21.Clearance Office Code Initial and Date: Deliver To: >>> . Authorized Requesting Official: (signature, title, phone, org. corresp. code) & date ; Phone: ; Org: ; Corresp. Code: ; Date: Title: 24. Received by: (signature & date) X form HUD -10.4 (3/85) American LegalNet, Inc. www.FormsWorkflow.com
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