ARC 6409B

The Disaster Receipt Form (6409-B) is to acknowledge receipt of product(s) and or service(s) requested on the Disaster Requisition Form (6409) by Group/Activity on the DRO.

DR #: Enter the DR # and year (If applicable).
DR Name: Enter the DR Name.
Requisition #: Requisition number from the corresponding F6409
Site POC: Enter the POC name
POC Phone: Enter POC’s Phone Number POC E-mail_ Enter POC’s E-mail

Description of product(s) and/or service(s)
Stock No.: Enter the Stock No. for the Item if known
Quantity: Enter the # of Units of Measure if known
Unit of Measure: Enter the Unit of Measure (EA-Each; PK-Pack;
CS-Case; BX-Box) if known

Total Qty (Each): Enter the number Quantity x Unit of measure = Total Each. If unit of measure is not known enter total number of product needed.
Description: Enter the description of the product(s) or service(s) Need by: Enter the date and time for when the product(s) or
service(s) are needed

Acknowledgement by person receiving item
Checkbox: Certifies receipt of items
Discrepancies: List any discrepancies here.
Received by (Printed name): Enter the name of the recipient Received by (Signature): Enter the signature of the recipient Date: Enter date in mm-dd-yy format
Time of Arrival: Enter arrival time
Group: Enter the Recipient’s Group/Activity/Position