Heavy Duty S-I Dater ORDER FORM.....RS-AG
Print this form , Fill it out and FAX or Mail it to us.
Your Info. 
.
Name .......................................................................
Company .................................................................
Address ....................................................................
City ........................................................................
State ............................. Zip Code .............................
Phone # ...................................................................
Fax # ......................................................................
E-mail .....................................................................
URL ........................................................................
Your P.O.# ....................................

maximum of 26 leters& spaces per line.............

MX 9105

Quantity: .........................

Number Stamps, Date Stamps

MX 9105-N

Quantity: .........................

Number Stamps, Date Stamps

MX 9220

Quantity: .........................

Number Stamps, Date Stamps

MX 9220-N

Quantity: .........................

Number Stamps, Date Stamps

MX 9330

Quantity: .........................

Number Stamps, Date Stamps

MX 9330-N

Quantity: .........................

Above

Custom Line #1 ....................................................................

Above

Custom Line #2 ....................................................................

Date Stamps, Number Stamps, Date Stamps, Number Stamps,

Below

Custom Line #1 ....................................................................

Below

Custom Line #2 ....................................................................

MX 9105 & MX 9105-N Prices include
1 custom line above & 1 custom line below date or number.
MX 9220, MX 9220-N, MX 9330 & MX 9330-N Prices include
1 or 2 custom lines above & 1 or 2 custom lines below date or number.
Shipping UPS ground $ 12.50 - All Orders, Any Quantity
State Tax will be added to CA orders only 9.25%

Advance Payment Required
No Returns Allowed on Custom Products.
25% Restocking Charge on Returned Stock Items.

...Method of Payment.............For Safety, Don't send credit card details over the Internet.

Master Card............ Visa............ American Expres......... Discover....... CHECK By Mail ............

Credit Card #... .... ......... .... .... .... ................... .... .... .... .....Expiration ...... / .........Billing ZipCode ...................