Past Due Notices Ordering Form

These are carbonized self mailer forms used on dot matrix printers for printing the late notice collection letters. If you wish to order past due notices then please fill out and submit the order form below.

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Prices effective September 1, 2002

Items marked with an * are required fields.

    NOTICE:  ALL SHIPPING CHARGES ARE THE RESPONSIBILITY OF THE CUSTOMER !!!

	Billing Information:
* Name
Title
* Organization
* Street Address
Address (cont.)
* City
* State/Province
* Zip/Postal Code
Country
* Work Phone
Ext.
FAX
E-mail

    NOTICE:  ALL SHIPPING CHARGES ARE THE RESPONSIBILITY OF THE CUSTOMER !!!

	SHIPPING INFORMATION
Purchase Order Number
* Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country

Preferred Shipping?	Overnight2-DayRegular
If Overnight or 2-Day Please provide:
The Name of your Shipping Company:
Your Shipping Account Number:

  (Note:  Past Due Notices are for Dot Matrix printers ONLY)
      

QUANTITY	COST	QUANTITY	COST
250	$ 55.00	750	$145.00
500	$ 99.00	1000	$190.00

* Quantity And Cost: $          N/A 250 @ $ 55.00 500 @ $99.00 750 @ $145.00 1000 @ $190.00  

NOTICE: CUSTOMER RESPONSIBLE FOR ALL SHIPPING CHARGES!!!