13. Supplier Certification - I hereby certify that the above statements for the supplier are true, accurate, and complete to the best of my knowledge. 14. 15. Signature of person completing for supplier Signature and title of certifying company official for supplier Purchaser Certification - I hereby certify that the above statements for the purchaser are true, accurate, and complete to the best of my knowledge. Signature of person completing form for purchaser Signature and title of certifying company official for purchaser Request for Determination - If supplier and wholesale purchaser cannot agree on base period purchases, purchaser should indicate that fact below, add any significant comments, and submit three copies to the appropriate FEO Regional Office. (Add sheets as needed.) Title 18 USC Sec. 1001 makes it a crime for any person knowingly and willfully to make to any department or agency of the United States any false, fictitious or fradulent statements or representations as to any matter within its jurisdiction. FEO-18(1-74)50M 43-187 O-75 - 17 Each supplier of any of these covered products should complete and submit form FEO-18 to each of his wholesale purchasers by January 15, 1974, or as soon thereafter as possible. The supplier should complete the form according to instructions below, a senior company official should certify the form, and it should then be mailed or otherwise delivered to the wholesale purchaser. Each wholesale purchaser who receives a form FEO-18 from a supplier should inspect the data entered by the supplier. If the wholesale purchaser agrees with all of the data entered by the supplier, he should keep the completed form FEO-18 on file. If the wholesale purchaser disagrees in any way with the data entered by the supplier, he should so indicate on the form. If the wholesale purchaser disagrees with the base period purchases as indicated by the supplier, he should enter the figures according to his records in column 12c. The wholesale purchaser should return completed form to his supplier. Suppliers and purchasers are encouraged to attempt to reach agreement on total base period purchases by direct negotiation. If no agreement can be reached, the supplier may allocate to the wholesale purchaser in the interim based on the supplier's records, and the wholesale purchaser may submit three copies of the completed FEO-18 to the appropriate FEO Regional office for resolution of the base period supply volume disagreement. Specific Instructions ITEMS TO BE COMPLETED BY SUPPLIER: 1. Purchaser Name of Company la. Enter the corporate name, or name of other entity as appropriate, of wholesale purchaser covered by report. 2. Purchaser - Address of Company 2a. Enter street number and street name of company location. 2b. Enter city of company location. 2c. Enter the state of company location. 2d. Enter ZIP code of company location. 3. (To be completed by wholesale purchaser) 4. Purchaser - Location for deliveries (if different from company address - item #2) 4a. Enter street number and street name of delivery location. 4b. Enter city as appropriate. 4c. Enter state as appropriate. 4d. Enter ZIP code as appropriate. 5. (To be completed by wholesale purchaser) 6. Supplier-Name of Company 6a. Enter the corporate name of supplier. 9b. Enter telephone number, including area code, where that person can be contacted for further information. 10. Date of Submission by Supplier to Purchaser 10a. Enter date by year, month, and day. 11. Type of Fuel-Check appropriate type for report being made. Only one may be checked on a report. 12. Total Base Period Purchases 12a. Enter the base period year; example - 1972. Note: Base period varies depending on the product. 12b. Enter total base period purchases by month for the wholesale purchaser covered in the report according to supplier records. 12c. (To be completed by wholesale purchaser) 13. Supplier Certification - Signature of person completing form for supplier and signature and title of certifying company official. 14. (To be completed by wholesale purchaser) 15. (To be completed by wholesale purchaser, if applicable.) Items to be Completed by Wholesale Purchaser: 3. Purchaser - Employer Identification Number (EIN) 3a. Enter nine (9) digit EIN as assigned by Internal Revenue Service. 5. Purchaser - Person to Contact Sa. Enter name of person to contact. Sb. Enter telephone number, including area code, where that person can be contacted for further information. 12. Total Base Period Purchases 12c. Enter total base period purchases by month from the supplier covered in the report according to purchaser records. 14. Purchaser Certification - Signature of person completing form for purchaser and signature and title of certifying company official. 15. Request for Determination - If supplier and wholesale purchaser cannot agree on base period purchases, purchaser should indicate that fact on an attached sheet(s), add any significant comments concerning the disagreement, and submit three copies to the appropriate FEO Regional Office. Approval of application of above end user/wholesale purchaser is recommended with the following changes: ACTION OF FEDERAL ALLOCATION OFFICER: (where required by state law or procedures) Application of above end user/wholesale purchaser is approved with the following changes: The supplier designated above is hereby directed to furnish the end user/wholesale purchaser also noted above with the following This quantity will be supplied in accordance with arrangements agreed upon by supplier and purchaser. Date/Period |