Signature Authorization for Submitting Printing and Binding Requisitions to GPO
I hereby certify that I have the authority to approve the following individual(s) as having signature authority to obligate funds on behalf of
Agency/Bureau/Department/Office/Location
to submit requisitions to the U.S. Government Publishing Office (GPO) in compliance with applicable regulations.
Authorized by
Name Job Title Signature
Phone Number Email Date
GPO Form 4064 04/19
Authorized Employee New addition? Yes No
Name Job Title
Wet Signature (required) Electronic Signature (if applicable)
Phone Number Email
Authorized Employee New addition? Yes No
Name Job Title
Wet Signature (required) Electronic Signature (if applicable)
Phone Number Email
Authorized Employee New addition? Yes No
Name Job Title
Wet Signature (required) Electronic Signature (if applicable)
Phone Number Email
Authorized Employee New addition? Yes No
Name Job Title
Wet Signature (required) Electronic Signature (if applicable)
Phone Number Email
Submit completed form to requisitions@gpo.gov
For questions call 202.512.1382 or email requisitions@gpo.gov
Note: If unable to submit form electronically, fax the completed form to 202.512.1260 or deliver to U.S. Government Publishing Office, 732 North
Capitol Street NW, Stop: CSPS, Room 848, Washington, DC 20401
click to sign
signature
click to edit
![]()
click to sign
signature
click to edit
![]()
click to sign
signature
click to edit
![]()
click to sign
signature
click to edit
![]()
click to sign
signature
click to edit
![]()
