Page 15 - DPA Brochure
P. 15

CHECK HERE  IF NEW  E  D  O  C     P  I  Z  PRICE
                         FLOOR, ROOM or SUITE NUMBER  SECURITY  FEATURE







                            T  E   ARABIC NUMBER  TO BE ON  CHECK ONLY  CHECK & STUB(S)  CHECK ONLY  CHECK & STUB(S)  CHECK ONLY  CHECK & STUB(S)  CHECK ONLY  CHECK & STUB(S)  SUB TOTAL  ADD 8% FREIGHT PLUS  $6.50  HANDLING  AR, AZ, CA, FL, GA, ID, IL, KS, LA MA, MD, MN, MO, MS, NC, NE, NJ, NV, NY, OH, OK, PA, SC,
                            A
          Toll Free: 800-660-8605  Local: 727-803-1495  Fax: 707-547-4553
                            T
                            S     SIGNATURE  LINES  ONE  TWO  ONE  TWO  ONE  TWO  ONE  TWO
              Fill in only if different from billing address at left. Do not use a P.O. Box number.  CHECK  USE  NUMBERS  LOGO  START AT  YES  NO  YES  NO  YES  NO  YES  NO






       FAST SERVICE ORDER FORM

                SHIP TO:  ATTENTION (PERSON ORDERING)  STREET ADDRESS  CHECK  BACKGROUND  NUMBER  N/A  N/A  EXP.  DATE:  Have you enclosed payment in full? (Make check payable to DPS Forms)




                2  FIRM NAME  CITY  COPY ALERT  CHECK  BLUE         GREEN  BURGUNDY  BROWN     PURPLE  BLUE         GREEN  BURGUNDY  BROWN     PURPLE  3



              CHECK HERE  IF NEW  FLOOR, ROOM or SUITE NUMBER  E  D  O  C     P  I  Z  MED. BROWN  TEAL  DK. GREEN  PURPLE  MED. BROWN  TEAL  DK. GREEN  PURPLE  MED. BROWN  TEAL  DK. GREEN  PURPLE  MED. BROWN  TEAL  DK. GREEN  PURPLE  MED. BROWN  TEAL  DK. GREEN  PURPLE  MED. BROWN  TEAL  DK. GREEN  PURPLE



                      PHONE  (          )         -  E  T  A  T  S  I WOULD LIKE MY FORMS/CHECKS TO BE PRINTED IN THE INK COLOR BELOW  SIENNA DK. BROWN  BLUE  NAVY  GREEN WARM RED  MAROON  WINE  SIENNA DK. BROWN  BLUE  NAVY  GREEN WARM RED  MAROON  WINE  SIENNA DK. BROWN  BLUE  NAVY  GREEN WARM RED  MAROON  WINE  S



              Is mailing address correct?  Make corrections here. DO NOT USE FOR PRODUCT PRINTING INFORMATION.  DESCRIPTION  GREY  BLACK  Check  PROCESS BLUE REFLEX BLUE  RED  ORANGE  BURGUNDY YELLOW  Check  GREY  BLACK  PROCESS BLUE REFLEX BLUE  RED ORANGE  BURGUNDY YELLOW  GREY  BLACK  Check  MARBLE PROCESS BLUE














                SOLD TO:  ATTENTION (PERSON ORDERING)  STREET ADDRESS  NO.  PARTS QUANTITY  (CIRCLE  ONE)  Laser  1  Continuous  1  2 NCR  3 NCR  4 NCR  Limited  Laser  1  Limited  Continuous  1  2 NCR  3 NCR  4 NCR  Laser  1  Continuous  1  2 NCR  3 NCR  4 NCR  MasterCard  DISCOVER  PLEASE CHECK! Have you checked




                1  FIRM NAME  CITY  FORM NO.
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