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REQUEST
FORM
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*Use the
"tab" key to move from blank to blank. If you hit the
"enter" key by mistake, do NOT click the default Return to
Form link on the error page. Hit the Back arrow button on your
browser.
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Request
number (please enter date)
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(## ## ##) month
date year - two digits with no / or - in between |
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How
will these be used?
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When
do you need them?
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(enter
"no specific date" if this is for an ongoing program or you
are doing advance research for an event several months away) |
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How
did you find out about us?
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(please list name ( ) of specific conference, person
referring, website, etc)
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customer |
( ) referred
me |
( )
salesperson |
| postcard mailing |
( ) conference |
( ) listserv |
| other - how? |
( ) internet search |
( )
newsletter |
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( ) website |
( ) magazine |
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First
Item # |
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Description
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Desired
Item Color
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(we
always try to send a sample in your desired color if one is
available. If not, another color will be substituted) |
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Desired
Imprint Color
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(we
always try to send a sample with your desired imprint color if one is
available. If not, another color will be substituted) |
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Item Size (if
applicable)
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What
quantity might you need?
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Second Item #
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Description
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Desired
Item Color
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Desired
Imprint Color
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Item Size (if
applicable)
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What
quantity might you need?
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SHIP TO ADDRESS:
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Name |
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Title/Office
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Organization/School
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Street
Address
(CANNOT SHIP TO A
PO BOX!)
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Address 2
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City
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State
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Zip
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Phone # and ext. #
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Fax
# |
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E-mail
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Charge
Shipping to
Fedex or UPS#
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or
credit
card
(required for samples valued over
$10. For items valued at over $25, we also charge for the sample. This may be returned to us for credit,
however, or deducted if you place an order)
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Additional
Comments
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Thank you for
your request.
We hope we can help make your program or event a success!
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*Please print this
form and read below if you are not using Internet Explorer as your browser!
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When hitting submit below, some customers using
the Mozilla Firefox and
MacSafari browsers have gotten a pop up email box instead of a confirmation of
submission page. If this happens, we will not receive your submission.
Please simply print and fax the form to us at (678) 482-0771 instead so that
we can respond immediately to your request. Thank you and sorry for the
inconvenience.
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