ACC-NJ GPC Pre-Approval Form
(Do NOT Use this form for Training, the SF 182 is required for training)
Requested By: / Request Number
Required Date: / Date Ordered:
Priority: / Routine / Urgent
Is this purchase for Electronic & Information Technology items (Section 508 of the Rehabilitation Act)?
Yes / No
Mandatory Government Sources must be
used if they satisfy the requirement. / AWARDEE VENDOR INFORMATION:
Vendor's Name:
MANDATORY SOURCES: / Address:
1. Agency Inventories / City, State, Zip:
2. UNICOR / Phone/FAX:
3. NIB/NISH (Ability One) / No Shipping Cost - FOB
4. DoD Emall / Purchase Amount (total):
5. GSA Advantage ( FSS) / Sales Rep.:
6. DLA Document Service(DAPS) / Estimated Delivery:
7. CHESS (Army IT – AR Regulation 25-1) / Confirmation #:
Reason for not using a Mandatory source:
Requestor must provide a justification for the request. Specific DETAILS are required.
Sources Contacted: / Date of Quote / Total Cost
1 Vendor Name
2 Vendor Name
3 Vendor Name
Item # / Description / Qty / Unit / Unit Cost / Total Cost
- / -$
- / -$
- / -$
- / -$
- / -$
Add’l charge (no sales tax) / -$
PLEASE SEE CONTINUATION SHEET / Grand Total: / -$
Agency Name:
Office: / Phone
Attn: / Bldg/Room
Address: / FAX:
City, State & Zip:
Cardholder Signature: / Date:
Billing Official Pre-Approval Signature: / Date:
Independent Receipt & Acceptance by 3rd Party (not by CH): { } Yes / Coordinate with PBO { } Yes*
If block is not checked yes, written explanation must be provided by CH