DRS envelope order form for Mail or Fax

Envelope No

Quantity

Description

Type Style

Ink Color

Unit Price

Print clearly and type imprint information on separate sheet and send with this order.
Print address upper left corner. Circle: Flush Left Centered Flush Right
If not circled we will print Centered.

		We accept MasterCard - Visa American Express - Discover
Order Form *Use your browser print button to print as many copies as you need*
Mail To: DRSFORMS-SYSTEMS.COM 24 Imperial Drive Selden, NY 11784	Fax to: (631) 696-4901 7/24	Office Hours: Monday - Friday 9:00 AM - 12:30 PM 1:30 PM - 5:30 PM Eastern Standard Time Toll Free: 1 (866) 696-0800

Date of Order
Customer Name
Ship to Address*
Ship to City, State, Zip
Telephone Number
Fax Number
E-Mail Address

PLEASE SEND ME: (Fill in only boxes that apply)

Shipping: Street Address only. No P.O. Box Numbers Samples Enclosed: Yes___ No___ Copy attached: Yes___ No___ Have you ever purchased from DRS before? Yes___ No___ Person to contact about this order: ____________________________	MERCHANDISE TOTAL
	SHIPPING CHARGE
	Sales Tax: N. Y State Residents
	TOTAL
Is this a ____ new order ____repeat order ____with change

Business Reply Envelopes

Is this order for Business Reply Envelopes? Yes____ No_____. If "Yes" do you want indicia or just address printed on face? Indicia Address only. If using indicia send us your 9 digit code or have the post office prepare your art for free.

Credit Card Information

Name as it appears on Card
Card Number
Expiration Date
Street Address where billed to
Zip Code where billed to

Customer Signature:_____________________________________________________________________________

Date: ________________________________

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