Page 15 - DPA Brochure

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.