DROP SHIP FORM
SECTION A
(To be filled by Shipping Supplier)
Complete / sign this form. After source inspection signs this form (and STR), include in
the Electronic CofC data package, AND include this form with the hardware when shipped.
SHIP TO LOCATION
Attn:
Carrier & Tracking No.
SHIP FROM LOCATION
R/D PO #
INVOICE #
DATE
P.O. ITEM QTY
PART NO. SERIAL NO.
Shipped By:__________________________ Title: ____________________________
(Please Print) (Please Print)
Signed: ______________________________ Date: ____________________________
Signature Source Inspection (if applicable) Date Stamp
____________________________________________________________________________________
Government Source Inspection (if applicable)
SECTION B
(To be filled by Receiving Supplier)
WE ACKNOWLEDGE RECEIPT OF THE ABOVE LISTED HARDWARE
Date Received:__________________ Note any exceptions:__________________
Received By:___________________ Title: _______________________________
Signed: _______________________
NOTE: THIS FORM MUST BE PROVIDED TO THE BUYER
Form 5003-G Rev 3/22/10