DD Form 428 "Communication Service Authorization"

What Is DD Form 428?

This is a form that was released by the U.S. Department of Defense (DoD) on May 1, 1999. The form, often mistakenly referred to as the DA Form 428, is a military form used by and within the U.S. Army. As of today, no separate instructions for the form are provided by the DoD.

Form Details:

  • A 1-page document available for download in PDF;
  • The latest version available from the Executive Services Directorate;
  • Editable, printable, and free to use;

Download an up-to-date fillable DD Form 428 down below in PDF format or browse hundreds of other DoD Forms compiled in our online library.

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Download DD Form 428 "Communication Service Authorization"

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COMMUNICATION SERVICE AUTHORIZATION
3. CIRCUIT OR BILL NUMBER
1. AUTHORIZATION
2. AUTHORIZATION
a. NUMBER
b. DATE
a. NUMBER
b. DATE
(YYYYMMDD)
(YYYYMMDD)
4. FROM
5. SUBMIT BILLS FOR CERTIFICATION TO
(Include ZIP Code)
(Include ZIP Code)
7. TELEPHONE NUMBER TO CONTACT FOR DETAILS
6. TO
(Communications Company)
(Include Area Code)
a. COMPANY NAME
8. AUTHORIZATION. In accordance with provisions of the contract
indicated above of which this authorization forms a part, authority
b. ADDRESS
is hereby given to Communications Company indicated in Item 6 to
(1) STREET
establish or perform services for official use as prescribed below at:
(2) CITY
(3) STATE
(4) ZIP CODE
9. SERVICE(S)
d. RATE PER MONTH
NON-RECURRING
DESCRIPTION
NUMBER
CHARGE
PER UNIT
TOTAL
a.
b.
c.
(1)
(2)
11. DISTRIBUTION
10. DISBURSING OFFICER MAKING PAYMENT
a. NAME (Last, First, Middle Initial)
b. GRADE
12. AUTHORIZING OFFICIAL
a. SIGNATURE
b. TITLE
c. GRADE
13. ACCEPTANCE
a. NAME OF CONTRACTING FIRM
b. SIGNATURE OF CONTRACTOR'S REPRESENTATIVE
c. DATE SIGNED
(YYYYMMDD)
DD FORM 428, MAY 1999
PREVIOUS EDITION IS OBSOLETE.
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COMMUNICATION SERVICE AUTHORIZATION
3. CIRCUIT OR BILL NUMBER
1. AUTHORIZATION
2. AUTHORIZATION
a. NUMBER
b. DATE
a. NUMBER
b. DATE
(YYYYMMDD)
(YYYYMMDD)
4. FROM
5. SUBMIT BILLS FOR CERTIFICATION TO
(Include ZIP Code)
(Include ZIP Code)
7. TELEPHONE NUMBER TO CONTACT FOR DETAILS
6. TO
(Communications Company)
(Include Area Code)
a. COMPANY NAME
8. AUTHORIZATION. In accordance with provisions of the contract
indicated above of which this authorization forms a part, authority
b. ADDRESS
is hereby given to Communications Company indicated in Item 6 to
(1) STREET
establish or perform services for official use as prescribed below at:
(2) CITY
(3) STATE
(4) ZIP CODE
9. SERVICE(S)
d. RATE PER MONTH
NON-RECURRING
DESCRIPTION
NUMBER
CHARGE
PER UNIT
TOTAL
a.
b.
c.
(1)
(2)
11. DISTRIBUTION
10. DISBURSING OFFICER MAKING PAYMENT
a. NAME (Last, First, Middle Initial)
b. GRADE
12. AUTHORIZING OFFICIAL
a. SIGNATURE
b. TITLE
c. GRADE
13. ACCEPTANCE
a. NAME OF CONTRACTING FIRM
b. SIGNATURE OF CONTRACTOR'S REPRESENTATIVE
c. DATE SIGNED
(YYYYMMDD)
DD FORM 428, MAY 1999
PREVIOUS EDITION IS OBSOLETE.
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Adobe Professional 7.0