Acroprint 125 & 150 Ribbons

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Company:_______________________________

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Address:________________________________

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Fax Number:____________________________

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Name:__________________________________

Company:_______________________________

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Address:________________________________

City:________________________State:______

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Acroprint 125 ribbon(12 or more ribbons) Quantity Ordered_____Price Each $7.20 Total ________

Acroprint 125 ribbon(36 or more ribbons) Quantity Ordered_____Price Each $5.40 Total ________

Shipping (flat rate continental U.S.A shipments)______________________________________$7.50

PA State  6% Sales Tax (PA SHIPMENTS ONLY) ____________________________Total_____________

Charge to my: [MasterCard]____[Visa]____[Discover-Novus]____[American Express]______

Cardholder Name:_________________________________________________

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Exp Date:_________________

Signature:________________________________________________________

Date:_________________