Partial Shipment	Complete Shipment	Purchase Order Number:
SECTION 1 – Order Information
Receiving Unit:	Receiver Name:
Address:
City:	State:	Zip:
Vendor Name:
Address:
City:	State:	Zip:
SECTION 2 – Receiving Detail
Item Description	Unit	1st Receiving Date	2nd Receiving Date
Quantity Received	Quantity Received
Property number required for items indicated with asterisk (*) on attached purchase order. Submit Form 3.22 Property Inventory Addition to Headquarters.
Remarks:
SECTION 3 – VDOF Agreement
I certify that the above listed merchandise or service was received on the date indicated in good condition, with exceptions as noted.
VDOF Employee Name (Print)	VDOF Employee Signature	Date
VDOF Headquarters Office/Finance Use Only
Audited to P.O.:	Audited to Invoice:	Posted to Stock:
Name	Date	Name	Date	Name	Date