Form Dd 771 is a Stock Purchase Agreement used between two or more parties to agree on the purchase and sale of stock. The form includes information on the seller, buyer, shares being sold, and the price per share. This document is often used in transactions between family members, friends, or business partners. It's important to understand what this form entails before signing it, as it can be legally binding. By understanding the contents of Form Dd 771 and any associated risks, you can make an informed decision about whether or not to sign it.
This page provides information about form dd 771. There, you'll obtain the details about the form you intend to fill in, such as the estimated time for you to complete it and also other details.
| Question | Answer |
|---|---|
| Form Name | Form Dd 771 |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | dd 771 form, dd 771 form printable, form 771, dd 771 |
(THIS FORM IS SUBJECT TO THE
PRIVACY ACT OF 1974 -
Use DD Form 2005.)
EYEWEAR
PRESCRIPTION
DATE
ACCOUNT NUMBER
ORDER NUMBER
TO: (Lab)
FROM:
NAME (Last, First)
ADDRESS/UNIT
ADDRESS CONTINUED
CITY, STATE, ZIP
SSN |
GRADE |
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PHONE |
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SHIP TO: |
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CLINIC |
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PATIENT |
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AD |
RES |
NG |
RET |
OTHER* |
A |
N |
AF |
MC |
CG |
PHS |
OTHER* |
FRAME |
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EYE |
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BRIDGE |
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TEMPLE |
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COLOR |
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DIST |
NEAR |
LENS |
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TINT |
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MATERIAL |
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PAIR |
CASE |
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PD |
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SPHERE |
CYLINDER |
AXIS |
DECENTER |
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H PRISM |
H BASE |
V PRISM |
V BASE |
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R
L
MULTIVISION
NEAR ADD |
SEG HT |
TOTAL DECENTER |
R
L
LAB USE
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PRIORITY |
TECH INITIALS |
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SPECIAL COMMENTS/JUSTIFICATION (*Use this space to specify blocks marked "Other.")
PRESCRIBING OFFICER/AUTHORITY
SIGNATURE
DISTRIBUTION: |
ORIGINAL - Retained by Lab. |
COPY 1 - Returned with eyewear. |
COPY 2 - Entered in health record. |
DD FORM 771, JUL 96
PREVIOUS EDITION IS OBSOLETE.