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On Line Order Form |
All line items with
"*" are required fields
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Company Name (if applicable): |
Contact Name * |
Address:* |
Address2: |
City:* State/Prov:* Zip/Post.
code:* |
Country:* Phone:*
FAX |
E-mail:* |
Please select type of
check below: |
LASER |
CONTINUOUS
FEED |
EKONOMIK |
Name of software: |
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Software version |
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Please select product number: |
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Quantity:* Beginning check #:* Color:* |
Please check one of the following |
Single
Duplicate Triplicate |
Please fill in the following information as it should
appear on your check: |
Name * |
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2nd Name (Optional) |
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3rd Name (Optional) |
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Address: * |
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Address: |
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City: * State/Prov: * Zip/Post. code: * |
Country: Phone Number: |
Bank Information. |
Bank Name * Branch (if applicable) |
Bank Address: * |
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BankAddress: |
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City:* State/Prov:* Zip/Post. code:* |
Country: * |
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Fill in bank numbers as they appear across
the bottom of your check. Please indicate spaces and
dashes! |
Banking numbers
* |
Routing #: Account
#: |
Payment options |
Master Card Visa Debit Card |
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Card number |
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Expiration date
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Card holder's name as it appears on card
* |
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Additional
information or comments about this order |
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YOU MAY ALSO FAX A COPY OF YOUR EXISTING
CHECK TO US AT:(503) 228-8444 OR YOU MAY SCAN AND E-MAIL A COPY OF
YOUR EXISTING CHECK TO US AT ORDER@CHECKPRINTINGCO.COM" |
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