Draft-O-Matic EZ Order Form

Draft-O-Matic
"Check Printing System"
by Nelson Publications

E Z O R D E R F O R M
Print This Form and Mail or Fax To:
Nelson Publications ~ 1600 Bryan Street, Ste B ~ Normal, IL 61761
Fax: (309) 452-7035 (24 hours)

I would Like to Order The Following:

[ ] Draft-O-Matic $54.95 ($49.95 + $5 Priority Shipping)
[ ] Draft-O-Matic $69.95 ($49.95 + $20 Overnight Shipping)
[ ] Draft-O-Matic & 300 Checks $72.95 (Priority Shipping)
[ ] Draft-O-Matic & 750 Checks $94.95 (Priority Shipping)
[ ] Draft-O-Matic & 1,500 Checks $129.95 (Priority Shipping)
[ ] 300 Checks for Draft-O-Matic $18.00 (Priority Shipping)
[ ] 750 Checks for Draft-O-Matic $40.00 (Priority Shipping)
[ ] 1,500 Checks for Draft-O-Matic $75.00 (Priority Shipping)
[ ] 300 Checks 3 Per Page No Waste $18.00 (Priority Shipping)
[ ] 750 Checks 3 Per Page No Waste $40.00 (Priority Shipping)
[ ] 1,500 Checks 3 Per Page No Waste $75.00 (Priority Shipping)

Please Ship To:

Company / Name:__________________________________________

Address:_________________________________________________

City / St / Zip:_____________________________________________

Phone & Fax:_____________________________________________

I would like to Pay By:

[ ] Check [ ] Money Order [ ] Faxing a Check [ ] Visa [ ] MasterCard

Credit Card Number:______________________________________________ Exp:________________

Name on card if different than above:___________________________________ Amount $_________

Billing Address if different than above:___________________________________________________

**If faxing a check, simply make it out in the correct amount, and attach it in this area and fax to number above.