REQUEST FOR BID
(PurchaseISale)
SECTION I - PURCHASE OF FOREIGN CURRENCY
1. DISBURSING ACTIVITY NAME AND LOCATION
2. DSSN
3. NAME AND ADDRESS OF BANK, FINANCIAL INSTITUTION, OR FOREIGN EXCHANGE DEALER
4. NAME OF FOREIGN CURRENCY REQUESTED
5. U.S. DOLLAR AMOUNT
PLEASE INDICATE THE NUMBER OF CURRENCY UNITS
DESCRIBED IN ITEM 4 YOU WILL FURNISH IN EXCHANGE FOR
EITHER A CHECK DRAWN ON THE TREASURER OF THE
UNITED STATES OR UNITED STATES DOLLARS IN THE
AMOUNT INDICATED IN ITEM 5.
6. DISBURSING OFFICER NAME, RANK OR GRADE
7. DISBURSING OFFICER'S SIGNATURE
8. DATE
9. UNITS AND TYPE OF FOREIGN CURRENCY OFFERED
10. PAY BY (Check one)
OFFER IS MADE TO FURNISH THE NUMBER AND TYPE OF
FOREIGN CURRENCY UNITS INDICATED IN ITEM 9. THE FORM
a. CHECK
b. CASH
OF PAYMENT REQUESTED FOR THIS CURRENCY IS
INDICATED IN ITEM 10.
11. NAME AND TITLE OF OFFERING OFFICIAL
12. SIGNATURE OF OFFERING OFFICIAL
13. DATE
14. CERTIFICATION
b. NUMBER OF BIDS
c. COMMISSIONED OFFICER NAME AND SIGNATURE
d. DATE
a. CERTIFIED TO BE THE
MOST BENEFICIAL
BID.
15. BID ACCEPTED
16. DISBURSING OFFICER NAME AND SIGNATURE
17. DATE
SECTION II - SALE OF FOREIGN CURRENCY
18. DISBURSING ACTIVITY NAME AND LOCATION
19. DSSN
20. NAME AND ADDRESS OF BANK, FINANCIAL INSTITUTION, OR FOREIGN EXCHANGE DEALER
21. NUMBER AND NAME OF FOREIGN CURRENCY UNITS
PLEASE INDICATE THE AMOUNT IN UNITED STATES DOLLARS YOU WILL FURNISH IN
EXCHANGE FOR THE NUMBER OF FOREIGN CURRENCY UNITS INDICATED IN ITEM 21.
22. DISBURSING OFFICER NAME, RANK OR GRADE
23. SIGNATURE OF OFFERING OFFICIAL
24. DATE
25. NUMBER AND NAME OF FOREIGN CURRENCY UNITS
OFFER IS MADE TO FURNISH UNITED STATES DOLLARS IN THE AMOUNT INDICATED
IN ITEM 25 FOR THE CURRENCY SPECIFIED ABOVE.
26. NAME AND TITLE OF OFFERING OFFICIAL
27. SIGNATURE OF OFFERING OFFICIAL
28. DATE
29. CERTIFICATION
b. NUMBER OF BIDS
c. COMMISSIONED OFFICER NAME AND SIGNATURE
d. DATE
a. CERTIFIED TO BE THE
MOST BENEFICIAL
BID.
30. BID ACCEPTED
31. DISBURSING OFFICER NAME AND SIGNATURE
32. DATE
33. REMARKS
DD FORM 2668, AUG 93
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