/ LASER & CONTINUOUS PURCHASE ORDER FORMPHONE: 800-494-5637
FAX: 800-553-4849
(Data must be sent via fax or mail) /

DATE

LASER

CONTINUOUS

BILL TO: Account Number:
Distributor Name:
Address:
City/ State/ Zip:
Attention:
Phone #:
Distributor P.O. #: / SHIP TO: (If same as BILL TO, check here )
Name
Address
City/ State/ Zip:
Attention:
Phone #:
Customer P.O. #:
ITEM INFORMATION
NEW
/
EXACT REPEAT
/
REPEAT W/CHANGES
/
LIFE #:
/
PREV. ORDER #:
SHIPPING:
UPS Ground OTHER / STANDARD PLUS CHECKS (click to drop down)
Pantograph #: / Color: Select ColorBlackReflex Blue300 Blue314 BlueProcess Blue348 Green328 TealPantone YellowWarm Red185 Red208 Burgundy151 Orange464 Brown471 Brown428 GrayPantone PurplePMS # is..
Border #: / Color: Select ColorBlackReflex Blue300 Blue314 BlueProcess Blue348 Green328 TealPantone YellowWarm Red185 Red208 Burgundy151 Orange464 Brown471 Brown428 GrayPantone PurplePMS # is..
Imprint Color: Select OneBlackReflex Blue300 Blue314 BlueProcess Blue348 Green328 TealPantone YellowWarm Red185 Red208 Burgundy151 Orange464 Brown471 Brown428 GrayPantone PurplePMS # is ...
2nd Imp.Color: NoneBlackReflex Blue300 Blue314 BlueProcess Blue348 Green328 TealPantone YellowWarm Red185 Red208 Burgundy151 Orange464 Brown471 Brown428 GrayPantone PurplePMS # is...Hologram Scallop Void / Laser Graphics:
YES NO
PMS Colors
Black / 300 Blue / 314 Blue / Process Blue / Reflex Blue
348 Green / 328 Teal / Pantone Yellow / Warm Red / 185 Red
208 Burgundy / 151 Orange / 464 Brown / 471 Brown / 428 Gray
Pantone Purple
RUSH: YES NO
QUANTITY: (If 3-to-a-page Laser Check, please indicate total number of checks)
FORM NUMBER:
SOFTWARE:
VERSION:
Please attach voided original sample of current format to help us ensure proper
registration with your software.
STARTING NUMBER:
SIZE OF FORM: /
STANDARD PLUS FORMS (available in colors listed above)
Form Color:
Imprint Color: Select OneBlackReflex Blue300 Blue314 BlueProcess Blue348 Green328 TealPantone YellowWarm Red185 Red208 Burgundy151 Orange464 Brown471 Brown428 GrayPantone PurplePMS # is... click to drop down)
2nd Imp. Color: NoneBlackReflex Blue300 Blue314 BlueProcess Blue348 Green328 TealPantone YellowWarm Red185 Red208 Burgundy151 Orange464 Brown471 Brown428 GrayPantone PurplePMS # is... 1 = Imprint and background color are the same.
If second color is selected, additional charges apply.
Perf Position:
Std 1/2" Left & Right:
YES NO /
Numbering: Max 2 Position
YES STG #:
NO
Laser Graphics:
YES NO
/
Back printing:
YES NO
NUMBER OF PARTS One Two Three
PERF POSITIONS (from top)
ARABIC NO.(S) None Check Stub(s)
CONSECUTIVE MICR NO. YES NO
COLLATE Face: Up Low Number: Top Bottom
CUSTOMER IMPRINT:
/
VOUCHER IMPRINT:
SIGNATURE LINE(S): One Two
Imprint In Signature Area:
Above Signature Line Below Signature Line /

ABA FRACTION

BANK IMPRINT:

BASIC BLACK IMPRINT CHECK YES NO
Choose Pantograph and Color (click to drop down)
Parkay
Panto
click hereReflex Blue348 Green209 Burgundy465 Tan
/

IMPRINT DEALER NAME YES NO

PHONE NUMBER:
FAX NUMBER:
STANDARD BLACK IMPRINT CHECK YES NO
Choose Pantograph and Color (click to drop down)
Linen
Panto
click here298 Blue209 Burgundy423 Gray348 Green465 TanReflex Blue / Marble
Panto
click here209 BurgundyReflex Blue328 Teal348 Hunter Green / Prismatic
Panto
Blue/Red/Blue / Scallop
Panto
click here209 Burgundy662 Blue357 Green / Hologram Scallop
Panto
click here209 Burgundy662 Blue357 Green
/

PROOF YES FAX / EMAIL:

SPECIAL INSTRUCTIONS:
Form Rev 1.31.11 / (A) ON US SYMBOL (B) DASH SYMBOL
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Rev 3/14/2016 03/14/16