JFB Desktop Publishing

11550 S. Harlan Rd #30, Lathrop, CA, 95330-9730

Fax: 209) 983-0187, Voice (209) 983-0019

Plaque 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.

. Information on electronic funds transfers to pay for purchases

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 & Part number unit: ea or Case PRICE QTY TOTAL
$
$
$
$
$
Sub Total $
Ca Residents add sales tax Sales Tax $
U.S .Shipping: UPS Ground track in Continental US (48 states)
Individual Plaques: $10.00 / First item, $5.00 each additional item up to a total of $25.00 for individual plaques below case quantity.
Cases: $30.00 / First case, $25.00 each additional case
LT100 & LT200:$12.00 First 25, $10.00 each additional $25
LT600 - LT800:$22.00 First 25, $18.50 each additional $25

Call or e-Mail for International Rates and for Alaska & Hawaii
$
TOTAL $

We thank you for your support.

Signature:_______________________________