3. Department/Government Establishment 4. Bureau or Office
5. Requisition Number 6. Billing Address Code (BAC) 7. Agency Location Code (ALC) 8. Line of Accounting (If applicable)
9. Treasury Account Symbol (TAS) / Business Event Type Code (BETC)
10. Cardholder’s Name 12. Email 13. Phone Number 14. GPOExpress 15. Address
11. Cardholder’s Title Card Limit 16. City, State 17. Zip Code
18. Credit Card Information
Name on Credit Card Credit Card Type
Credit Card Number (enter numbers only, no dashes) Expiration Month Year Card Spending Limit per
Billing Agency Billing Street
Billing City Billing State Billing Zip Code
Cardholder Phone Cardholder Email
Name Phone
19. GPOExpress eView Administrator’s Contact Name 20. eView Administrator’s Telephone Number 21. eView Administrator’s Email
22. Financial Contact’s Name 23. Financial Contact’s Telephone Number 24. Financial Contact’s Email
25. Primary Contact’s Name 26. Primary Contact’s Telephone Number 27. Primary Contact’s Email
28. Address 29. City 30. State 31. Zip
I certify that this work is authorized by law and necessary to the conduct of the business of the above-mentioned government establishment.
I understand that GPO Form 3001 Authorizes Funding for the GPOExpress program.
32. Name of Authorizing Official
33. Authorizing Signature
34. Title of Authorizing Official
Participation Request
1. Jacket Number
Renewal: If you are renewing your GPOExpress account(s), check this box and print or type
your full name and sign at the bottom of this form.
2. Date
To name additional cardholders, please continue on page 2.
GPO Form 3001 (R 4/19)
CLEAR FORM PRINT FORM
If you do not want to fill out the above credit card information, please check this box and fill in your name and phone number to speak with a GPO representative.
Note: Sections 4-7 do not need to be completed if registering with a credit card.
TAS*:
Sub-level
Prefix Code
Allocation
Transfer
Agency
Identifier
Agency
Identifier
Beginning
Period of
Availability
Ending
Period of
Availability
Availability
Type Code
Main
Account
Code
Sub-Account
Code
BETC*
click to sign
signature
click to edit
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