REQUISITION/ PROCUREMENT REQUEST FOR EQUIPMENT PAGE OF

SUPPLIES OR SERVICES (Instructions on reverse) 1 PAGES

2. REQUISITION/PROCURMENT 3. ACT NUMBER 4. DATE PREPARED 5. JOB/PROJECT NUMBER
REQUEST NO.

6. TO (Stockroom/Contracting office, Name and Location) 7. FROM (Requisitioning office, Name, Symbol, Location and Telephone Number)

8. FOR INFORMATION CALL (Name and Telephone Number) 9. RECEIVING OFFICE (Name, Symbol and Telephone Number)

10. ACCOUNTING CLASSIFICATION 11. SHIP TO (Address, ZIP Code and Telephone Number)
FUND ORG. CODE B/A CODE O/C CODE

FUNC CODE C/E CODE PROJ/POS. NO. CC-A

W/ITEM CC-B PRT/CRFT 12. CONTRACT NUMBER

ITEM NO. FORM OR QUAN- UNIT OF UNIT

STOCK NUMBER DESCRIPTIONS OF ARTICLES OR SERVICES TITY ISSUE PRICE AMOUNT
(13) (14) (15) (16) (17) (18)

19. TOTAL AMOUNT

IF ADDITIONAL SPACE IS REQUIRED, USE GSA FROM 49A, REQUISITION/PROCUREMENT REQUEST INCLUDING
CONTINUATION
20a. TYPED NAME AND TITLE OF FUND CERTIFYING OFFICAL 21a. TYPED NAME OR REQUISTIONER

20b. SIGNATURE DATE 21b. SIGNATURE DATE

22. LIST ATTACHMENTS 23a. TYPED NAME OF APPROVING OFFICAL

23b. SIGNATURE DATE

24. SHIPPED BY

FREIGHT PARCEL POST EXPRESS MAIL

25. FILLED BY 26. PACKED BY 27. CHECKED BY

28. BILL OF LADING NUMBER 29. DATE SHIPPED

GENERAL SERVICES ADMINISTRATION GSA FORM 49 (REV. 7-91)

 INSTRUCTIONS FOR PREPARATION OF (GSA FORM 49)

GENERAL, The GSA Form 49, Requisition/Procurement 10. Enter the accounting classification against which
Request for Equipment, Supplies or Services, must be used the requisition/procurement request will be charged. If
as the basic procurement request form when requisitioning multiple accounting classification are required, the
s u p p l i es not ava i la b le fr om cu s to mer Su ppl y C en te r s , information should be entered in blocks 13 through 18 or on
equipment, services (including architect-engineer and other the GSA Form 49A, Requisition/Procurement Request for
related services) and construction (see GSA Handbook, Equipment, Supplies or Services (Continuation).
Preparing Procurement Request and Receiving Reports,
APD P 2800.14). The GSA form 49 ,Must also be used to 11. Enter the address, including room number, where
requisition forms and publications for the GSA National applicable, building and telephone number to which the items
Forms and Publication Center. The GSA Form 49 is not to are to be delivered. Whenever appropriate, use GENERAL
be used as a printing requisition or to order motor vehicles SERVICE ADMINISTRATION and an office symbol as the
from the Federal Supply service Automotive Commodity first line of the address.
Center. Use GSA Form 50, Requisition for Reproduction
Services, to order printing services and GSA Form 1781, 12. Fill in this block only if a procurement request is
Motor Vehicle Requisition, to order motor vehicles. requesting the exercise of an option, a contract modification,
or an order against an existing contract. Enter the number of
REQUISITION/ PROCUREMENT REQUEST IDENTIFICATION the existing contract.
NUMBER. All procurement request submitted to a
contracting office must be assigned a number for 13. List one number for each line item requisitioned
identification purposes. The number used may be the ACT whether the line is a single item, or a quantity of that
number (block 3) or a requisition/procurement request item. Indicate the appropriate stock number, if any.
number (block 2). Assignment of a identification number is
optional for requisitions for forms, publications and 14. If a stock number has been entered in block 13,
telephone service. enter only the noun name of the item being requisitioned.
COPIES. Procurement request must be prepared in an Otherwise, described clearly and fully the supplies or services
original and two copies, unless otherwise specified by the being requisitioned. Include any special requirements or
contracting office. The original and one copy must be r es t r ic ti o ns an d r eq ui r e d j us ti f ic a tio n s i t h i s b l o c k. I f
forwarded to the appropriate contracting office and one address and telephone number. If more space is needed,
copy will be retained by the program office. The number of types across the full page in the space available in blocks 13
copies of other requisitions will be as prescribed by the through 18 or on GSA Form 49A.
office receiving the GSA Form 49.
15. Enter the quantity of units for each item number.
INSTRUCTIONS FOR COMPLETING THE BLOCK: The
numbered blocks will be completed as described below: 16. Describe the type of unit, e.g., dozen, square foot,
manhour.
1 . En t er t h e to t a l nu mb er o f pa ge s in t h e
requisition/procurement request. 17. Enter the unit price for each unit described.

2. Enter the number assigned by the requisitioning office. 18. Enter the estimated price for total number of
Procurement request numbers, if assigned, must be units requested.
numbered consecutively by fiscal year and consist of the
requisitioner's office symbol, fiscal year and a number, e.g. 19. Enter the estimated price for ALL items
V-88-1, V-88-2. completion of this block is optional. requisitioned.

3. Assign an Accounting control Transaction (ACT) 20. Enter the name, title and office symbol of the
number in accordance with NJEAR system procedures. official who is authorized to certify the availability of funds\
and the correctness of financial data in block A. The official
4. Enter the date on which the requisition/procurement must sign in block B.
request is prepared.
21. Enter the name, title and office symbol of the
5. where appropriate, enter the job/project number (or originator of the requisition/procurement request in block A.
title if necessary for identification) of the job/project to be The named official must sign in block B.
charged for the requisition/procurement.
22. Briefly list all attachments to the GSA Form 49.
6. Enter the organization title, office symbol, and
location of the appropriate office. 23. Enter name, title and office symbol of the
official approving the requisition/procurement request, as
7. Enter the organizational title, office symbol, location, required by office policy, e.g., supervisor, branch chief,
and telephone number of the requisitioning office. director, in block A. The named official must sign in block B.

8. Enter the name and telephone number of the person 24-29. Personnel from the GSA National Forms and
who can furnish additional information concerning the publications Center will complete these blocks. Not
requisition/procurement request. applicable to procurement request.

9. Enter the name, office symbol and telephone number

of the office responsible for completing the receiving reports.

GSA FORM 49 BACK (REV. 7-91)