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PART REQUEST, EXTERNAL CUSTOMERMaintenance Operations DivisionDATEMaintenanceWork CenterPART 1 – UNIT INFORMATIONDODAACUICUNIT ADDRESSPOINT OF CONTACTPHONE NUMBERCOM:DSN:FAX:E-MAILCommander Signature (Include Assumption Of Command Orders with Request)Commander E-MailPART 2 – END ITEMNSNNOMENCLATUREMODELSERIAL NUMBERManufacturerRemarksPART 3 – PART(S) REQUESTEDNSN/PART #NOMENCLATUREQTYCOSTMaintenance OrderPART 4 – SUPPLY ACTIONSDATE PART(S) ORDEREDDATE PART(S) SHIPPEDSHIPPING METHODSTO NUMBERSIGNATURE This form may be reproduced but shall contain the same information as it appears on this form. MOD Form 858 20190220 ................
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