STAMP REQUISITION FORM
Customer Information
Date: ______________
Name: __________________________________ Phone Number: ______________
Department: _____________________________ Floor/Room # ________________
Address: ______________________________________________________________
E-Mail Address: ________________________________________________________
Chartfield Number: _
____
-
__ - _____ - _____ - _____
________________________________________________________________________
Stamp Order * (Maximum 400 stamps per denomination) *
Stamp
Description
Increment
(rolls of 100,
First Class
max of 400)
(sheets of 10,
Global Forever
max of 400)
(sheets of 20,
2 cent stamps
max of 400)
Increment
Unit Price
Sold
Total
Price
Amount
Needed Total Cost
$0.49
100
$49.00
$ 0.00
$1.15
10
$11.50
$ 0.00
$0.02
20
$0.40
$ 0.00
Total
$ 0.00
* A check made payable to Postmaster – New York must accompany any Stamp
Requisition Form when ordering more than the 400 stamp maximum quantity limit
Please complete form, save and then e-mail to [email protected]
________________________________________________________________________
Mail Services Use Only
Order Filled By: ______________________
Date: ______________
Delivered By: ________________________
Date: ______________
RESET
revised January 2017