Printing Communications Associates, Inc. - PCAUSA Order Form Contact Information ------------------- Contact Name : ___________________________________________________ Company Name : ___________________________________________________ Street Address : ___________________________________________________ : ___________________________________________________ City : ___________________________________________________ State/Province : ____________________ ZIP/Postal Code: _____________ Country : ___________________________________________________ Telephone : ___________________________________________________ Fax : ___________________________________________________ E-Mail : ___________________________________________________ Billing Address (If different from Shipping) -------------------------------------------- Contact Name : ___________________________________________________ Company Name : ___________________________________________________ Street Address : ___________________________________________________ : ___________________________________________________ City : ___________________________________________________ State/Province : ____________________ ZIP/Postal Code: _____________ Country : ___________________________________________________ Unit Total Part Number Description Quantity Price Price -------------+-------------------------+----------+----------+-------- | | | | -------------+-------------------------+----------+----------+-------- | | | | -------------+-------------------------+----------+----------+-------- | | | | -------------+-------------------------+----------+----------+-------- Form: 2/1/99 Subtotal | +-------- Sales Tax (Note 1) | +-------- Shipping (Note 2) | +-------- Total | +-------- Payment Method -------------- [ ] PO:________________ (Please FAX Purchase Order) [ ] Wire Transfer [ ] Visa [ ] MCard [ ] American Express Credit Card Information ----------------------- Card Number: __________________________________________ Exp: ____/____ Cardholder Name: _____________________________________________________ Note 1: In the U.S., add the applicable sales tax on orders shipped to Georgia. Note 2: Shipping Charges E-Mail : No Charge Canada/Mexico : $25.00 United States: $15.00 Other/International: $35.00 Mail Orders To: Fax Orders To: --------------- -------------- Printing Communications Associates, Inc. FAX: (770) 234-4182 4201 Brunswick Court Smyrna, GA 30080 USA