On-Line
Order Form

721 York Street, P.O. Box 72430
Newport, KY 41072-0430

Phone: (859) 261-2035
Fax: (800) 261-TAGS (8247)
International Fax: (859) 261-TAGS (8247)

Email Address:
(Required so we can confirm receipt of your order)

Purchase Order Number:
Purchasing Department Email Address:
Purchasing Department Phone Number:
(Required for any institution that uses purchase orders)

Billing Address:

Name
Company
Street(POB)
City	State	Zip Code
Country
Phone
FAX

Delivery Address: (if different from "Billing Address")

Name
Company
Street
City	State	Zip Code
Country
Phone
FAX

Today's Date: Date Delivery Required: (mm/dd/yyyy)

Shipping Method:

UPS Parcel Post Next Day Air 2nd Day Air Truck Other

Payment Method:

MasterCard Visa Discover American Express
If you'd like to open an account, check here and we'll fax or mail a credit application.
Bill Us: Account No.

Cardholder's Name
Credit Card#
Expiration Date	(mm/yy)
Security Code (on back)

Quantity

Style

Size

Color

Material

Item Name

Number Series

Starting #

Ending #

Special Stamping
(spec. dimensions, holes, etc.)

Weight

Unit Price

Totals

SPECIAL CHARGES: Add only when they apply to your order.
Shipping & Handling Charges: Multiply weight times zone, then add $6 for Total Shipping & Handling

Shipping and Handling Charges (UPS Ground or Parcel Post only- contact us for quote on other methods)

Zone 1
$.40/lb.

Zone 2
$.50/lb.

Zone 3
$.70/lb.

Multiply
weight
times
zone then
add $6 for
Total
Shipping &
Handling

Total lbs. Weight

TERMS

Zone Charge
X $

+ $6.50=

TAX (KY Residents only)

Minimum Order
$25.00

Total $

Special Instructions:

When finished, press Submit Order to send.

Thank You!

On-Line Order Form

Email Address: (Required so we can confirm receipt of your order)