FAX COVER SHEET
A
Date: To: Fax #: From: RE: Type your text in here Sender or cardholder Title (253) 571-xxxx DESK (253) 571-xxxx FAX September 26, 2008
Administrator/BRC Name Title, Location /Dept Name
address Tacoma . WA . 984xxx 253.571.xxxx Main 253.571.xxxx FAX
Card #: Name Appearing on Card: Charges to be billed to card: Bill to address: John Doe total not to exceed $
Expiration Date:
601 South 8th Street, Tacoma, WA 98405
Authorized Signature: ___________________________________________________ Please fax back confirmation numbers to my attention at the Fax # listed above: CONFIRMATION NUMBERS: ____________________________________________
The documents accompanying this fax transmission contain information belonging to the sender which is legally privileged and confidential. The information is intended only for the use of the individual or entity named above. If the reader of this message is not the intended recipient, you are hereby notified that any disclosure, dissemination, distribution, copying or the taking of any action in reliance on the contents of this information is strictly prohibited. If you have received this communication in error, please notify the sender immediately by telephone, and maintain its confidentiality by destroying or returning the facsimile to the sender via U.S. postal services. Thank you.
P:\Permanent_Keep\Forms\Finance Forms\52eb09e9-8e6f-4cab-846a-43434567531f.doc
9/26/2008