JFB Desktop Publishing

112 Eucalyptus Ave., South San Francisco, CA 94080

Fax: (650) 872-2774 Or (800) 794 -8345

Anniverary Seals Order Form

Fill out this order form and print it. Mail or fax it to me . Keep a copy for your records.
We do not trust the web with credit cards. There is always the possibility a talented hacker can compromise you. However, if you really want to submit electronically use the

Name:

Address:



Ship to Above Address   Ship to Below Address

Ship To:


Payment Options: Mail with Cashier's Check
Mail with Personal Check (wait for check to clear)
Pay by Credit Card


Credit Card:

 Visa
MasterCard
American Express
Discover


Card number : Expiration : Security code from back of card



Name on Credit Card:


Card Billing Address:

Home Phone with Area Code :

Day Phone with Area Code :    Fax Number:

E-mail :


Description of Seal and item #

Foil Gold Silver
Ink Red Blue Green Black
Quantity 1,000 - $280.00 3,000 - $660.00 5,000 - $900.00 10,000 - $1,600

Company Name: 

City and State ( optional) 

Aniversary#:   Year Started:  year of Aniversary:

Set Up fee $50.00
Quantity:
Shipping: $10.00
Total:

We thank you for your support.

Signature:_______________________________