ARC Disaster Requisition -  FORM 6409
                                                                                                                                           Form 6409 Instructions

DR# (if applicatable):     DR Name:     Date:         Requisition # :  
Requestor Name : Signature:
Title : Phone:
Delivery Information
Site POC Name :     Phone:     Email:  
Address: 
City:    State:     Zip:      
Description of product(s) and/or service(s)
Stock No.
Quanity
Unit of measure
(EA/PK/CS/BX)
Total QTY (each)
Description
Date needed
Special Instructions :  
The following information must be filled in by the APPROVER ONLY:
Approval includes verification of need; need consistent with Service Delivery Plan and budget.
Approver Name : Signature:
Title : Phone:
Procurement Method (This section is optional) :
Account string to charge: - - - - -                              
Procurement tool to use: Donation ReQuest Concur Invoice P-card Transfer Loan

Other: (Explain) :


                                                                                                    ARC 6509 v. 0.12

DCS JT DMWT Disaster Requisition (F6409) V.2.0 2015.02.13

 

ARC 6409

The ARC Requisition 6409 and the ARC Disaster Receipt 6409-B are designed to work together.

Station#1 will fill out the Requisition 6409, and send to Station #2 to fill the order.

When station #2 receives and views the 6409 request, there is a button on the viewer form to "Save Requisition 6409 data for Receipt form 6409B"

Then station #2 loads the 6409B form Data. They can load the data from the original order by clicking the button "Load Requisition form 6409 data";

If needed the order can be modified as the order is filled-
example if 10 cases of water are not available and only 5 cases can be shipped, they can modify the order to reflect what they are sending.

The 6409B order is then send to Station #1. When the order is delivered, they complete the section of the 6409B
"Acknowledgement by person receiving product(s) and/or service(s)."
and send it back.
- - - - - - - -

Please complete the blocks on this form as indicated below:
DR #: Enter the DR # and year (if applicable)
DR Name: Enter the DR Name
Date: Enter date in mm-dd-yy format
Requisition #: Requisition number if used. On DROs the logistics workers assign a number for tracking purposes.
Requester’s Information
Prepared by (Printed Name): Enter the Requester’s Name. Please write legibly.
Prepared by (Signature): Enter the Requester’s Signature Title: Enter the Requester’s Title or Group/Activity/Position

Delivery Information
Site POC: Enter the Site Point of Contact name Phone: Enter POC Phone number.
E-mail: Enter POC E-mail
Address: Enter Delivery street address
City: Enter Delivery City State: Enter Delivery State Zip: Enter delivery zip code

Description of product(s) 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
Special Instructions: Enter any special requirements that did not fit in description section above. Example 1: Call POC two hours before delivery. Example 2: Drop trailer needed for products. Example 3: Order only if product or service is donated (IKD).

Approver
Approver’s Name: Enter the Name of Approver Signature: Enter the Signature of the Approver Title: Enter Approver’s Title
Phone: Enter Approver’s Phone Number
Procurement Method (This section is optional)
Accounting string to charge: Enter the accounting string. The approver is responsible for this validation.
Procurement tool to use: Check the box for: Donation, ReQuest, Concur Invoice, P—card, Transfer, loan or other. Attach this form to the procurement method.

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