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					                                                The Electronic Avenue, Inc.
                                                     SUPPLY ORDER FORM
                                           Shipping is not included with the prices below.

     PRODUCT                    PRICE      QUANTITY     TOTAL          PRODUCT                  PRICE              QUANTITY            TOTAL
                                                                      All Nurit
VERIFONE                                                              Terminals
PRINTER 250                                                           Elite 710 / 712
                                                                      All Talento
1 Paper Roll 2          1.25                                          Terminals
ply                                                                   1 Thermal Roll                 1.50
10 Paper Rolls 2      11.99                                           10 Thermal Rolls              14.50
ply                                                                   48 Thermal Rolls              67.00
50 Paper Rolls 2      55.99                                           - Case
ply - Case
1 Ribbon                5.99
(red/black)
1 P900 Ribbon           5.99                                          Verifone Omni
                                                                      Terminals
                                                                      Exadigm Terminals
                                                                      1 Thermal Roll                1.65
MANNUAL                                                               10 Thermal Rolls             16.00
IMPRINTERS                                                            48 Thermal Rolls -           71.00
           Manual       35.00                                         Case
Imprinter
100 – 2 Part Short Pack                4.99
1000 – 2 Part Short                   45.99                           Nurit 8000 Wireless
4000 – 2 Part Short Case             190.99
100 – 2 Part LONG                      5.05
1000 – 2 Part LONG                    45.99                           1 Thermal Roll                        1.55
4000 – 2 Part LONG                   179.99                           10 Thermal Rolls                     14.00
                                                                      48 Thermal Rolls - Case              66.00

                                                                                            SHIPPING INFORMATION
CELL PHONE                                                            Business Name
PRINTERS                                                              Street Address
                                                                      City/State/Zip Code
           10 Roll Pack           15.95                               Phone Number
25 Roll Pack                      35.95
                                                                      Email
50 Roll Pack                      55.00

                                                                      SUB- TOTAL:
                                                                      Tax (Arkansas) 9%
POS Systems – Receipt Printers
                                                                      Total Before Shipping
                                                                      Shipping Preference                    Ground       2 day  Next Day
THERMAL PAPER
1 – 3” Thermal Roll                 1.55
10 – 3” Thermal Rolls              14.99                              TOTAL DUE:
50 – 3” Thermal Rolls              72.00                                             *Shipping Cost will be filled in by iPayment.
1 – 4” Thermal Roll                 3.95
10 – 4” Thermal Rolls              39.00                                                        PAYMENT METHOD
50 – 4” Thermal Rolls             189.00                              Credit Card Number
                                                                      Credit Card Exp. Date
BOND PAPER                                                            CVV2#
1 – 3” 1-ply Roll                   1.20                              Signature
10 – 3” 1-ply Rolls                10.95
                                                                      Date
50 – 3” 1-ply Rolls                27.95
1 – 4” 2-ply Roll                   1.99
10 – 4” 2-ply Rolls                                                   Please subtract the amount
                                   18.95                                                                    □ YES
50 – 4” 2-ply Rolls                89.95                              from my checking account.             Sign: _________________________

                                                                      *NOTE: If you do not see your terminal or printer listed please call 1-888-
FILL IN THE BLANKS AND WHAT YOU WANT                                  665-4431. Some models have been discontinued because of Visa and
                                                                      MasterCard regulations regarding truncation. Also, this form will be your
                                                                      receipt.

                                                                      Email Orders to: 1wehmeyer@earthlink.net
                                                                      Fax Orders to: 1-800-846-0914
                                                                      Call In Order: 1-888-665-4431

				
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