WS Form 17 Supply Depot Order Form

National Management Information System (Wildlife Service)

WS 17 Jan 2011

National Management Information System - Private Sector (Respondents)

OMB: 0579-0335

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According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0579-0335. The time required to complete this information collection is estimated to average .065 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

OMB Approved

0579-0335

EXP XX/XXXX

United States Department of Agriculture

Animal and plant health inspection service

Wildlife services


Pocatello supply depot order form


Through: (Name, Address, and Telephone of State Director)

Please furnish in accordance with instructions below the following items, and charge same to my account, payment there for to be made promptly upon delivery and receipt of invoice.

ship to (name and Address of Consignee)





via

Invoice to

pestocode applicatoe license number

charged to: (Show Appropriation Number, if applicable)

Item Number

Description of Supplies

(for pesticides, list name and APHIS registration number)

Quantity

Size

Containers

Unit Price

and Unit

Amount





$

$


TOTAL

$

Requested by




Form prepared by

Address




Telephone number

Date

Signature of approving state director, WS, APHIS, USDA




date

for supply depot use only

Invoice number

b/l number

mail or fax original to:


pocatello supply depot

238 e. dillion street, pocatello, idaho 83201

commercial: (208) 236-6920

Fax: (208) 236-6922


shipped by

date shipped

Invoiced by

WS FORM 17 Previous edition may be used.

JAN 2011

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
Authorsmharris
File Modified0000-00-00
File Created2021-01-29

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