IMS IMS

							                                                   IMS

               HASLER SUPPLY ORDER FORM
      To insure your company’s safety online, please fill out the form. Upon completion, save the
        document as Order For (Company Name) and email it to HMcKenzie@imsofdayton.com.

    Company Name:____________________________________________
    Address (No PO Boxes please):________________________________
    City, State ZIP______________________________________________
    Phone Number:_________________ Purchase Order #_________
    Attention:_________________________________________________
           MACHINE MODEL NUMBER (Please highlight one in BOLD = CTRL B)


    Whisper Jet WJ     20      60     65     90     95      110    135    150    180   185

                         215        220    250    330     350     420    460    480

   SUITEM                                               PRICE                          QUANTITY

    Ink Cartridge (USPS Approved) WJ 20                  $89.95 each                   _________

    Ink Cartridge (USPS Approved) WJ 60-110             $185.00 each                   _________

    Ink Cartridge (USPS Approved) WJ 135-185     $206.00 each                          _________
    (Includes timeout: Approx. 30,000 Impressions)

    Ink Cartridge (USPS Approved) WJ 135-185     $110.00 each                          _________
    (Includes no timeout: Approx. 8,000 Impressions)

    Print Head (Black Cartridge)                         $235.00 each                  _________
    (USPS Approved) WJ220-250

    Ink Tank (White Plastic Tank)                        $245.00 each                  _________
    (USPS Approved) WJ220

    Ink Tank (White Plastic Tank)                        $415.00 each                  _________
    (USPS Approved) WJ250

    Ink Cartridge (USPS Approved) WJ 330-480            $124.00 each                   _________

    Thermal Roll Tape Labels (WJR30/5R)                 $99.95 per 3,000 labels        _________

    Single Tapes (900-401-0-4)                          $49.95 per 1,200 tapes         _________

    Double Tapes (900-402-0-4)                          $69.95 per 2,400 tapes         _________

    Double Tapes (900-4080)                         $19.95 per 600 tapes               _________

    Pinwheel Tapes (PINW)                               $19.95 per 600 tapes           _________
SBP Template (Includes S & H)              $24.95 each              _________

                                                               Total $________
Shipping and Handling: Minimum of $10.00 plus anything over standard weight

ALL ORDERS WILL BE SHIPPED USPS AND RECEIVED WITHIN 2 to 3 BUSINESS DAYS

Type of Credit Card (BOLD One=CTRL B): Visa       MC
Credit Card #:
Credit Card Expiration Date:
Name on Credit Card: