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Federal Agency Stamp Requisition

PS Form 17-G, August 2014 PSN 7530-01-000-9499


Instructions
1. This form is ONLY to be used by Federal Agencies that have an Official
Mail account. Type or print clearly. Please obtain approval for the order
from your Agency Mail Manager.
2. Minimum dollar value per order is $40.00. Orders received for less
than $40.00 will have additional coils of stamps added to the order to
satisfy the minimum order. Stamps are available only in multiples
Panes of 20, Books of 20 or Coils of 100. For all additional
denominated stamps, please inquire by sending email to
[email protected].
3. In the Ordered By block, enter your name and government
department/agency contact information, including address, telephone
number with area code, email address, and the name of your federal
government department/agency.
4. Enter in numeric only, the Date of Order, the Agency Code, and the
Agency Cost Code in the blocks provided. (Agency Code and Agency
Cost Code are special codes you receive from your headquarters mail
manager.) The Agency Code must be entered. The Agency Cost Code
(provided by your agency) is preferred.
5. Enter the name and complete address of the individual to whom the
stamps will be sent in the Shipping Label block.
6. TO ORDER: Multiply the number of stamps, coils, or boxes by the
denomination or unit price. Enter the totals in each category of
purchase (stamps, coils or boxes). Add each category then enter the
total dollar and cents amount for the order in the Requisition Total
column.
7. Keep a copy for your records.
8. New as of August 2014, this form can be sent via fax to 816-545-1201,
email: [email protected] or send via mail to:
Stamp Fulfillment Services Order Entry
8300 NE Underground Dr.
Pillar 210
Kansas City, MO 64144-9998
Ordered By
Name and Title
Street Address
City, State, ZIP+4

Telephone Number (Include area code)


E-mail Address
Signature
Department/Agency
Date of Order Agency Code Agency Cost Code

Month Day Year


S
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Description/
Denomination
Quantity of
Panes or
Books
X Price = Amount
1
Pane of 20
X 20 =
2
Pane of 20
X 40 =
3
Pane of 20
X 60 =
4
Pane of 20
X 80 =
21
Pane of 20
X $4.20 =
34
Pane of 20
X $6.80 =
$1.00
Pane of 20
X $20.00 =
$5.00
Pane of 20
X $100.00 =
49
Book of 20 (Forever)
X $9.80 =
Total Stamp Denomination Purchase
C
o
i
l

S
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p
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Description/
Denomination
Quantity
of Coils
X Price = Amount
21
Coil of 100 for 2nd ounce
X $21.00 =
34
Coil of 100 for Postcards
X $34.00 =
49
Coil of 100 FCM (Forever)
X $49.00 =
Total Stamp Unit Purchase
S
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p
e
d

E
n
v
e
l
o
p
e
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Description
Quantity
of Boxes
X Price = Amount
#10 Regular Envelope
Box of 500
$265.40
Total Stamped Boxed Envelope Purchase
Requisition Total $
Print Clearly -- This Is Your Shipping Label
Name & Title
Office/Unit
Street Address
City
State Zip+4

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