Sample Order Form

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                                                        Please fax this completed form and a copy of your purchase order to

                                                                                                                               CID #

                                     Date: April 10, 2013                                      Purchase Order #
                                    Name:                                                                 Name:
     E-mail:                   Company:                                                               Company:
      Web:                  Bill To Addr.                                                         Ship To Addr.
                                      City:                                                                 City:
                                  County:     Fresno County                                            State/ZIP
                                 State/ZIP                                                               Phone:
                                   Phone:                                                                   Fax:
                                      Fax:                                                                Email:

            Credit Card:                                              Card Number:                                                Exp. Date
                                                                   Cardholder Name:
     Visa              Master Card

     Discover          American Express

Item Code/Paper Type                          Product Description                      Size        Length           Quantity Price Each       Total
                                                                                                                                 Subtotal:    $0.00
                                                                                                                        Tax:      7.875%      $0.00
                                                                                                                                  TOTAL:      $0.00
Instructions on how to fill out the required fields on the order form:

                      1                                                2                            3             4
         Item Code/Paper Type                             Product Description                     Size      Length
                8650000042                                     20# inkjet bond                   36" roll   300 ft
               BMHR240001                                  24# inkjet pres. paper                  36"       100'

This workbook auto-calculates your purchases as you add in quantities and unit prices. All parts
of this order form are meant to coincide completely with the price list provided either on the website
or by your CVIS media specialist. If you find any problems with items on this price sheet (like the
tax rate for your specific county, absence of your county in the list, or feel that the totals are not
correct), please call 1-800-511-8020 and report the problem immediately.

1. This is where to enter the paper code that the paper is identified by in the price list.
2. This is where to enter the paper weight (#) and description
3. This section identifies what the paper size is. For rolls enter the roll size (36 inches in this case)
If it is a sheet instead of a roll, then enter both dimensions here (example: 24x36) and skip #4
4. Enter the roll length (in feet) in this section
5. How many of the specified item you want to order. If this is a repeat order with multiple items and
you don't want to order a particular item, just put zero here (like in the example above) and it won't be
tallied in the final total. This is particularly useful if you often order the same things but not all at once.
You can just save this file to your hard drive when you have all of your common papers entered and set
the quantities for each order as you need them. Say goodbye to having to write down the same thing
over and over again!
6. Individual unit price. From current price sheet.
7. Automatically calculated total using the quantity and unit price. The tax is factored in and based
on the county selected when the purchaser's information was entered. Totals are always subject to
approval by CVIS to ensure that you are receiving the best price possible!
   5         6            7
Quantity Price Each     Total
   2       $21.66      $43.32
   0       $21.39       $0.00
           Subtotal:   $43.32
   Tax:     7.875%      $3.41
           TOTAL:      $46.73
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