CONTRACTOR

INVOICE

JUNE 2022

YES

SUPT. DOCS. NOTIFIED

NO

CONTRACTOR TOTAL QUOTE

SUPT. DOCS. QUANTITY ORDERED

SUPT. DOCS. COST ADDITIONAL RATE

SUPT. DOCS. DELIVERY ADDRESS

FOR ADDITIONAL INFORMATION CONTACT: EMAIL PHONE NO. FAX NO.

AUTHORIZING SIGNATURE TITLE DATE SENT TO CONTRACTOR

ORDER RECEIVED BY: (Agency Representative) DATE ORDER RECEIVED

All contractor invoices are to be FAXED to GPO at 202.512.1851. For instructions on how to prepare your bill and get paid go to www.gpo.gov/vendors/payment.htm

I certify that the materials/services ordered have been delivered on the date indicated above and that payment or credit has not been received. 

The penalty for making false statements to the Government is prescribed in 18 USC 1001.

CONTRACTOR SIGNATURE DATE

THIS FORM MUST BE FURNISHED TO GPO UPON SUBMISSION TO CONTRACTOR. ADDITIONAL INFORMATION

Supplemental Information Attached

DELIVERY DELIVER PRODUCT TO: RETURN FURNISHED MATERIALS TO:

Distribution List Attached

Digital Print Acceptable? Yes No

Digital Deliverables Requested - Format: Native PDF

I certify that I am an authorized agency representative of the above-mentioned Government establishment with authority to submit this order to the U.S. Government Publishing Office and obligate its funding in compliance with 

applicable regulations, and; this work is authorized by law and necessary to the conduct of the business of the above-mentioned Government establishment. SPECIFICATIONS

One Side

Only

Head to 

Head

Head to 

Foot

QUALITY 

LEVEL

DAYS DEPT. WILL 

HOLD PROOFS

QUANTITY (unit of finished product)

TRIM SIZE

COVER COATING TYPE

TEXT COATING TYPE

INDICATE WHICH COVERS PRINT

NUMBER OF 

TEXT PAGES

x

1 2 3 4

PROOFS

Electronic 

Soft Proof

Inkjet

(QTY)

Content

(QTY)

High Resolution

(QTY)

(QTY)

Prior to Production Samples

(QTY)

PRINT

PRESS SHEET INSPECTION

 No. of Hours Notice 

PAPER COVERS

 (Self) (Separate)

FURNISHED ELECTRONIC MEDIA

 Files to be sent via FTP or Email CD/DVD 

OTHER GOVT. FURNISHED MATERIALS

COVER PAPER COLOR OF COVER INKS

TEXT PAPER COLOR OF TEXT INKS

ULC SIDE SADDLE COMB COIL PERFECT BOUND SEW TAPE TRIM 4 SIDES

STITCH BINDING

OTHER

PURCHASE CARD NO. (Info to appear on GPO copy only)

BILLING INFO

AGENCY LOCATION CODE (ALC)

EXP. DATE NAME AS IT APPEARS ON PURCHASE CARD

BILLING ADDRESS CODE (BAC) * APPROPRIATION CHARGEABLE/OBLIGATION NO.

PURCHASE

CARD

LINE OF ACCOUNTING/DOCUMENT REFERENCE NUMBER

(Info Will Appear on IPAC as Entered)

PHONE NO. OF CARDHOLDER

TAS*: 

Sub-level 

Prefix Code

Allocation 

Transfer 

Agency 

Identifier

Agency 

Identifier

Beginning 

Period of 

Availability

Ending 

Period of 

Availability

Availability 

Type Code

Main 

Account 

Code

Sub-Account 

Code

BETC*

G-INVOICING (GINV) GTC# ** GINV ORDER# ** ORDER LINE# ** ORDER SCHEDULE# **

**Must use number as generated by G-Invoicing system

Simplified Purchase Agreement

Work Order Form 4044

You are hereby authorized to manufacture and ship the following described product in 

accordance with the purchase order and specifications indicated.

* Required Fields

REQ. NO. *

DATE PREPARED OBJECT CLASS

JACKET NO. * PROGRAM NO. * WORK ORDER NO. *

PURCHASE ORDER NO. * STATE CODE * CONTRACTOR’S CODE * SHIP/DELIVERY DATE

DEPARTMENT OR GOVERNMENT ESTABLISHMENT

CLASSIFICATION *

CONTRACTOR

PUBLICATION TITLE

QUOTES DUE BY

Classified Yes

No SBU PII Yes

No

Yes

No
THIS FORM MUST BE FURNISHED TO GPO UPON SUBMISSION TO CONTRACTOR. JUNE 2022

Supplemental Instructions PAGE 2

REQ. NO. JACKET NO. PROGRAM NO. WORK ORDER NO. 

CONTRACTOR PURCHASE ORDER NO. STATE CODE CONTRACTOR’S CODE

ADDITIONAL INFORMATION

PUBLICATION TITLE BILLING ADDRESS CODE (BAC)

DEPARTMENT OR GOVERNMENT ESTABLISHMENT

Simplified Purchase Agreement

Work Order Form 4044