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                                                                                                                                                                                                   Northeast Customer Service
                                                                                                                                                                                                   62 White St.
                                                                                                                                                                                                                                                  South & West Customer Service
                                                                                                                                                                                                                                                  4435 Old Winter Garden Road
1.       FAX your order. If you must confirm, mark it                                                                                                                                              New York, NY 10013-3593                        Orlando, FL 32811-4240
         “CONFIRMATION” to avoid duplication of the order.                                                                                                                                         (800) 221-2972                                 (800) 327-9220
2.       Call us. Fill in this order form first to speed service and keep                                                                                                                          (212) 431-7000                                 (407) 299-8220
         a record.                                                                                   For shipment from our nearest plant call                                                      FAX (800) 561-9018                             FAX (800) 262-8208
3.       If you do not have an account or credit card, fax a check.
         See CHAX® procedure on back.
                                                                                                     800 LAW MART (529-6278)                                                                       Southeast Plant                      Northeast Plant                         West Plant
                                                                                                                                                                                                   Orlando, FL                           Menands, NY                         Arlington, TX
                                                                                                    e-mail: order@blumberg.com
Ordered by:                    KEY CODE: BE006
For correct order processing, please write legibly.                                 Order at www.blumberg.com and receive one Standard Clause free (value $9.50). Click                                                                C o r p o r a t e , L L C & L P P r oducts.
                                                                                    This ord e r f o rm can be filled in on the Internet or downloaded in a PDF format to be filled in and faxed at
Attention                                                                           w w w.blumberg.com/contact.html
Firm Name                                                                           Section A—               Complete Kits,                     Seal,            Certificates
Street Address, Suite/Floor                      (    Business or      Residence)      Corporate           LLC        LP Kit Catalog No._____________(For Calif. corporations, also see section below.) Price.......................$_______________
City, State, Zip                                                                    State of ___________________________ Year of organization (for seal) ____________ Name is printed in CAPITALS unless specified otherwise.
Important: we will contact you if we have a question about the order.
                                                                                           Print corporate, LLC or LP name exactly as on organization document. (If longer than 45 characters, including spaces, add $12.50 for 2” die seal.)
Tel. & Ext.                                     Fax                                 For corporations:
                                                                                        No. of shares authorized ____________            No par value or            Par value $__________ per share          Loose Certificates (for SharePrinter).
Email
                                                                                    Certificates signed by______________________________________________________________________                             Certificates bound if not checked.
                                                                                    (Default titles, Corp.: President and Secretary-Treasurer; LLC: Member-Manager; and LP: General Partners)
Ship to: (If different from “Ordered by”)
                                                                                    Corporation Options: Green border certificates supplied unless                  blue,          orange or             brown specified.
Attention                                                                           Additional lithographed certificates_________@ .28 ea ................................................................................................................................$_______________
                                                                                    IRC § 1244 complete set, plans, instructions, etc., $9.95 extra ....................................................................................................................$_______________
Firm Name
                                                                                    Standard clause No._____________ (see list on page 46) $9.50 extra (One clause FREE, if you order online.) ................................................$_______________
Street Address, Suite/Floor                       (    Business or     Residence)   LLC Options:         Authorized_____________Units of Membership Interest, or                    Representative or                Percent certificates
City, State, Zip
                                                                                    Orders including seals: If 2" die seal required, add $12.50 ..................................................................................................................$_______________

Charge:                   MC         Visa             AmEx                           California Corporations only—Print the following clause (no charge for one clause), green certificates only.
                                                                                                   5C standard clause (non-registration under state or federal law, use with § 25102(f) exemption)
Card Number                                                         Expires
                                                                                                   7CA2 Close corporation and transfer condition § 25102(h)                                   7CA1 Transfer condition § 25102(h)
Signature
                                                                                       California Professional Corporations
        BlumbergExcelsior Account Number                                                           “Appropriate legends.” Tell us the profession. We will supply the “appropriate legend” on the certificate
        Check enclosed. Indicate amount $ ______________________                              (available with green borders only) $29.95 extra ............................................................................................................................$_______________
        Open a house account (fill in the Application pdf at                                        Professional By-laws (Blank State), Cat. No. 5162, $6.50 extra ..............................................................................................$_______________
        w w w.blumberg.com/contact.html and
        email it to sl@blumb.com, or download and fax to us).                       No shipping charges on orders $50 or more, orders under $50, add $8.95 (Seals and stamps, $4.25.) ..........................................$_______________
        Fax an application to: __________________________________ Express Shipments:                             Charge my account: Carrier______________________ Acct. No.___________________________________________
        Fax No.: ______________________________________________                                                                                   HI, AK, PR                                     For Express Shipment                   $_______________
                                                                                    Charges For Kits, Seals, Certificates:  48 States      Major cities    Remote                                Subtotal                               $_______________
                                                                                    2nd Day                                 $9.95          $21.75          $35.00
Most corporate kits shipped within 24 hours.
                                                                                    Next Day                                $28.98         $39.95          $51.00
The same day if ord e r received by noon!
                                                                                    For deliveries in AL, AR, AZ, FL, GA, MS, NC, NY, SC, TX or VA, add applicable sales tax. Shipping charge is taxable. ..............................$_______________
No gr o u n d s h i p p i n g c h a r g e s o n o r ders $50 and                     No COD’s accepted.                                                                    Total price of corporate kit, certificates or seal . . . $_______________
over to the lower 48 states and for Priority Mail
of corporate kits to AK, HI, VI, PR & Guam.
FAX A CHECK WITH YOUR ORDER
      FOR FAST SERVICE!                                                          See other side for ordering information                                                                                                     ®                                             ®

We use the CHAX® system to prepare a negotiable CHAX                             800 LAW MART (529-6278)
check that is treated like an original check by the banking
system. Your order will be entered without delay.                                This order form can be filled in on the Internet or downloaded in a PDF format to be filled in and faxed. Go to
1. Prepare, sign and date a check in the usual way.                              www.blumberg.com/contact.html
2. Faxing a check is an authorization to charge your bank
     account as per the faxed check.                                             Section B—Individual Items
3. Fax copy of check with your order to 800 561-9018.                            Cat. No.                      Description and/or color                                                                               Size                  Qty.              $ Price
4. Keep the original check for later reconciliation.


Ordered by:                    KEY CODE: BE006
For correct order processing, please write legibly.

                                                                                                                                                                                                      Add shipping and tax and total at bottom
Attention

Firm Name                                                                        Section C—Imprinted, Thermographed, Engraved and Printed Products
Street Address, Suite/Floor                      (    Business or   Residence)   Cat. No.                      Description and/or color                                                       Format                  Size                  Qty.              $ Price

City, State, Zip

Important: we will contact you if we have a question about the order.


Tel. & Ext.                                    Fax


Email                                                                            For certain products imprinting costs are extra and must be added to the base price. Consult catalog.                                                Subtotal                $__________________

                                                                                 1. Name
         Ship to: (If different from “Ordered by”)                                                                                                                                                           Type styles for imprinted covers, envelopes, labels, etc.
                                                                                 2. Counselor at Law, Attorney at Law, etc.                                                                                    Match enclosed sample as closely as possible
Attention                                                                                                                                                                                                      Roman                  GILBERT AND SULLIVAN
                                                                                 3. Street Address
Firm Name                                                                                                                                                                                                      Gothic                 GILBERT AND SULLIVAN
Street Address, Suite/Floor                      (    Business or   Residence)
                                                                                 4. City, State & Zip Code                                                                                                     Cheltenham             GILBERT AND SULLIVAN
                                                                                                                                                                                                               ARIAL                  GILBERT AND SULLIVAN
City, State, Zip                                                                 5.Telephone Number, if included in imprint.


                                                                                 6. FAX Number, if included in imprint.                                           7. Email, if included in imprint.
Charge:                   MC        Visa             AmEx
                                                                                 Options for legal covers, will supplies and mailing envelopes:
Card Number                                                    Expires
                                                                                   Printing on flap of top bound covers @$6.00 (4 line maximum) ........................................................................................................$_______________
                                                                                   Assorted colors or stock @ $4.50 each change ......................................................................................................................................$_______________
Signature
                                                                                   Combine different sizes on imprinted covers @ $5.50 for each change of size ....................................................................................$_______________
        BlumbergExcelsior Account Number ______________________
                                                                                 Engraved, thermographed and printed stationery and imprinted products:
        Check enclosed. Indicate amount $ ______________________
                                                                                    Match enclosed samples as closely as possible.                         Follow enclosed layout.
        Open a house account (fill in the Application pdf at                       Send proof by; FAX to (_________) _______________________________, mail, email to_____________________________________
        w w w.blumberg.com/contact.html and
                                                                                 Subtotal all items ordered above (Section B, Minimum Order: $30.00) ..................................................................................................$_______________
        email it to sl@blumb.com, or download and fax to us).
                                                                                 Orders under $50, add $8.95 for handling and shipping ............................................................................................................................$_______________
        Fax an application to: __________________________________
                                                                                 For deliveries in AL, AR, AZ, FL, GA, MS, NC, NY, SC, TX, or VA, add applicable sales tax. Shipping charge is taxable...............................$_______________
        Fax No.: ______________________________________________
                                                                                                                                                                                                                                                        Total $_______________

				
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