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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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