PO # _______________________
Office Use Only __________
Date _________________________
THE UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER
AT HOUSTON
MAIL SERVICES STAMP FORM
ACCOUNT CHARGED ________________________________________
ACCOUNT TITLE ___________________________________________
The authorized signature below certifies that the requested postage stamps are to be used for official University of Texas business only.
AUTHORIZED BY_________________________________________
PHONE NUMBER: _________ (Please
Sign and Type Signature)
Return Stamps to: Room __________ Building __________
Request for Stamps – NOT FOR RESALE
Denomination |
Unit of Issue | Amount Ordered | Amount Issued | Unit Price | COST | |
|---|---|---|---|---|---|---|
| .42 | Roll |
$42.00 |
||||
| .02 | Sheet | $.40 | ||||
| Forever | Booklet | $8.40 | ||||
| TOTAL: | ||||||
Receipt Acknowledged: ______________________________
(Sign and Date)
This page is to be printed, completed and mailed to Mail Services at OCB 1.960 for processing.