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LAUNDRY LIST (FOR PIECE-RATE PATRONS)

For use of this form, see AR 210-130; the proponent agency is DCS, G-4.
LAST NAME-FIRST NAME-MIDDLE INITIAL GRADE LAUNDRY USE ONLY
MARKER TOTAL PIECES

ORGANIZATION TEL EXT CHECKER AMOUNT

DATE
QTY INDIVIDUAL ITEM AMT QTY HOUSEHOLD ITEM AMT
BAG, LAUNDRY APRON
BELT BLANKET
BLOUSE CLOTH, WASH
CAP COVER, CHAIR
COAT COVER, COUCH
COVERALLS CURTAIN (sq. yd.)
DRAWERS NAPKINS
DRESS PILLOW CASE
GLOVES RUG
HANDKERCHIEF SHEET, SINGLE
JACKET, FIELD SHEET, DOUBLE
JACKET, MIL CIV SPREAD, SINGLE
PAJAMAS SPREAD, DOUBLE
SHIRT SS LS TABLE CLOTH (sm-med-lg)
SHIRT, SWEAT TOWEL
SHIRT, UTILITY
SHORTS OTHER
SKIRT
SLACKS
SOCKS, PR
TROUSERS, CIV
TROUSERS, JEAN
TROUSERS, UTILITY
TROUSERS, SWEAT
UNDERSHIRT

DATE PICKED UP
CLAIMS MUST BE ACCOMPANIED
BY THE LAUNDRY SLIP AND
SHOULD BE SUBMITTED BY THE
PATRON TO THE LAUNDRY
SIGNATURE OF PATRON
MANAGER, WITHIN 72 HOURS
AFTER PICKUP, EXCLUDING
NON WORKDAYS.

DA FORM 2741, MAY 86 EDITION OF MAR 68 IS OBSOLETE. APD V2.01

LAUNDRY RECORD COPY


LAUNDRY LIST (FOR PIECE-RATE PATRONS)
For use of this form, see AR 210-130; the proponent agency is DCS, G-4.
LAST NAME-FIRST NAME-MIDDLE INITIAL GRADE LAUNDRY USE ONLY
MARKER TOTAL PIECES

ORGANIZATION TEL EXT CHECKER AMOUNT

DATE
QTY INDIVIDUAL ITEM AMT QTY HOUSEHOLD ITEM AMT
BAG, LAUNDRY APRON
BELT BLANKET
BLOUSE CLOTH, WASH
CAP COVER, CHAIR
COAT COVER, COUCH
COVERALLS CURTAIN (sq. yd.)
DRAWERS NAPKINS
DRESS PILLOW CASE
GLOVES RUG
HANDKERCHIEF SHEET, SINGLE
JACKET, FIELD SHEET, DOUBLE
JACKET, MIL CIV SPREAD, SINGLE
PAJAMAS SPREAD, DOUBLE
SHIRT SS LS TABLE CLOTH (sm-med-lg)
SHIRT, SWEAT TOWEL
SHIRT, UTILITY
SHORTS OTHER
SKIRT
SLACKS
SOCKS, PR
TROUSERS, CIV
TROUSERS, JEAN
TROUSERS, UTILITY
TROUSERS, SWEAT
UNDERSHIRT

DATE PICKED UP
CLAIMS MUST BE ACCOMPANIED
BY THE LAUNDRY SLIP AND
SHOULD BE SUBMITTED BY THE
PATRON TO THE LAUNDRY
SIGNATURE OF PATRON
MANAGER, WITHIN 72 HOURS
AFTER PICKUP, EXCLUDING
NON WORKDAYS.

DA FORM 2741, MAY 86 EDITION OF MAR 68 IS OBSOLETE. APD V2.01

CUSTOMER COPY
LAUNDRY LIST (FOR PIECE-RATE PATRONS)
For use of this form, see AR 210-130; the proponent agency is DCS, G-4.
LAST NAME-FIRST NAME-MIDDLE INITIAL GRADE LAUNDRY USE ONLY
MARKER TOTAL PIECES

ORGANIZATION TEL EXT CHECKER AMOUNT

DATE
QTY INDIVIDUAL ITEM AMT QTY HOUSEHOLD ITEM AMT
BAG, LAUNDRY APRON
BELT BLANKET
BLOUSE CLOTH, WASH
CAP COVER, CHAIR
COAT COVER, COUCH
COVERALLS CURTAIN (sq. yd.)
DRAWERS NAPKINS
DRESS PILLOW CASE
GLOVES RUG
HANDKERCHIEF SHEET, SINGLE
JACKET, FIELD SHEET, DOUBLE
JACKET, MIL CIV SPREAD, SINGLE
PAJAMAS SPREAD, DOUBLE
SHIRT SS LS TABLE CLOTH (sm-med-lg)
SHIRT, SWEAT TOWEL
SHIRT, UTILITY
SHORTS OTHER
SKIRT
SLACKS
SOCKS, PR
TROUSERS, CIV
TROUSERS, JEAN
TROUSERS, UTILITY
TROUSERS, SWEAT
UNDERSHIRT

DATE PICKED UP
CLAIMS MUST BE ACCOMPANIED
BY THE LAUNDRY SLIP AND
SHOULD BE SUBMITTED BY THE
PATRON TO THE LAUNDRY
SIGNATURE OF PATRON
MANAGER, WITHIN 72 HOURS
AFTER PICKUP, EXCLUDING
NON WORKDAYS.

DA FORM 2741, MAY 86 EDITION OF MAR 68 IS OBSOLETE. APD V2.01

INTERIM FILE COPY