DD FORM 250, AUG 2000
MATERIAL INSPECTION AND RECEIVING REPORT
PREVIOUS EDITION IS OBSOLETE.
Form Approved
OMB No. 0704-0248
The public reporting burden for this collection of information is estimated to average 30 minutes 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. Send comments regarding this burden estimate or any other aspect of this collection
of information, including suggestions for reducing the burden, to the Department of Defense, Executive Services and Communications Directorate (0704-0248). Respondents should be aware
that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB
control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION.
SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
1. PROCUREMENT INSTRUMENT IDENTIFICATION
(CONTRACT) NO.
ORDER NO.
2. SHIPMENT NO. 3. DATE SHIPPED 4. B/L
TCN
5. DISCOUNT TERMS
6. INVOICE NO./DATE 7. PAGE OF 8. ACCEPTANCE POINT
9. PRIME CONTRACTOR
CODE
10. ADMINISTERED BY CODE
11. SHIPPED FROM (If other than 9) CODE FOB: 12. PAYMENT WILL BE MADE BY CODE
13. SHIPPED TO CODE 14. MARKED FOR CODE
15.
ITEM NO.
16. STOCK/PART NO.
DESCRIPTION
(Indicate number of shipping containers - type of
container - container number.)
17. QUANTITY
SHIP/REC'D*
* If quantity received by
the Government is the
same as quantity shipped, indicate
by (X) mark; if
different, enter actual quantity received below
quantity shipped and encircle.
18.
UNIT
19.
UNIT PRICE
20.
AMOUNT
21. CONTRACT QUALITY ASSURANCE
a. ORIGIN
CQA ACCEPTANCE of listed items
has been made by me or under my supervision and
they conform to contract, except as noted herein or
on supporting documents.
DATE
SIGNATURE OF AUTHORIZED
GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE
NUMBER:
b. DESTINATION
CQA ACCEPTANCE of listed items has
been made by me or under my supervision and
they conform to contract, except as noted herein or
on supporting documents.
DATE
SIGNATURE OF AUTHORIZED
GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE
NUMBER:
22. RECEIVER'S USE
Quantities shown in column 17 were received in
apparent good condition except as noted.
DATE RECEIVED
SIGNATURE OF AUTHORIZED
GOVERNMENT REPRESENTATIVE
TYPED NAME:
TITLE:
MAILING ADDRESS:
COMMERCIAL TELEPHONE
NUMBER:
23. CONTRACTOR USE ONLY
