Custom Order Form Bemiss Jason

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To get a quote or place an order for custom examination books,
print out and complete the order form below.
Fax:
Mail:
800-806-7946 or (920) 997-4774
Bemiss-Jason,
Attn: Customer Service/Blue Book Division
P.O. Box 7170, Appleton WI 54912-7068
Custom Examination Blue Book
Order/Inquiry Form
Order ______
Inquiry ______
(Check one)
Bill to Address:
Ship to Address:
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
P.O. Number: ______________________________________________________________
Company/University: ________________________________________________________
Contact Person: ____________________________________________________________
Phone Number: _____________________________________________________________
Fax Number: _______________________________________________________________
E-mail Address: ____________________________________________________________
Order Quantity (number of books): _____________________________________________
Color of Ink:
Blue: ________
Black: ________
(Check one)
Color of Cover:
Blue: ________
Pink: ________
Yellow: ________
Green: ________
White: ________
Other: _________
Book Size:
__________________ x _________________
Number of Writing Pages: __________
(A writing page is one side of a sheet of paper. Example: an 8 writing page booklet contains 4 sheets of paper
which equal 8 writing surfaces.)
Cover Design:
Stock: ________
Custom Design: ________ (Check one)
If Custom Design, then specify University: ________________________________________

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