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Order Form

Office Easel / P.O. Box 763 / Bloomington, IN / 47402-0763 / 1-800-541-8152 / Fax: 1-866-517-7379

Bill to:

Office		Attention
Address		City/State/Zip
Phone		Fax
New Customer? Yes No

Ship to (if different from above -- must be a street address):

Office		Attention
Address		City/State/Zip

Payment Method:
Bill me
Check Enclosed
Visa Mastercard American Express

Credit Card Number: Expiration Date: Card Holder Name:

Order Information:

Qty	Item #	Message*	Size*	Imprinted (X if yes)	Color*	Description	Price	Total
							Subtotal	$
							Shipping	$
							IN Residents 6% sales tax	$
							Total	$
Imprint information and/or comments

* if applicable