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Please read carefully then follow instructions on form for Foil Seals:

To order Foil Seals PRINT THIS PAGE on Your Printer First, fill in the Questions, Sign, and mail complete form with CASH or MONEY ORDER IN US DOLLARS, MONEY ORDER MUST BE PAYABLE ON A US BANK to D. Moore at P.O.Box 183 - Hillview, Kentucky 40129-0183 . Allow 5-10 working days for return. Don't forget to add cost of mailing if You want any special return mailing. There is no returns or refunds on this product, due to it being a special order.

Important: PLEASE print or type where I may read it, there will not be a refund due to errors caused by not being able to read the order form!

•ORDER•FORMFOIL SEAL•

Note: Please fill in the following information exactly as wanted printed on SEAL if ordering laser printed seals!

TO BE COMPLETED FOR FOIL SEAL ORDER :

1. PLAIN FOIL SEAL (NO WORDING OR LOGO):___________

2. COLOR OF SEAL (GOLD, RED, SILVER, BRONZE, OR HAND EMBOSSED) : ________________________________

3. QUANTITY ORDERED (MIN. 500 UNLESS OTHER ARRANGEMENTS HAVE BEEN MADE : ____________________________________

4. IF LASER PRINTER PLEASE PROVIDE WORDING AND/OR LOGO TO BE APPLIED:

ACROSS TOP OF SEAL : _________________________________________________________________________________

ACROSS BOTTOM OF SEAL: _____________________________________________________________________________

CENTER OF SEAL (WORDING): ____________________________________________________________________________

CENTER OF SEAL (LOGO): _________________________________________________________________________________

SELECTION OF PRE-EMBOSSED SEALS (PLEASE SELECT BY NUMBER # _______________________________ VIEW HERE


•MAILING INFORMATION•

Within the USA Mail to: Name ___________________________________________________________

Address: Street and Number _____________________________________________________________

City: ___________________________________, State: _____________________Zip: ______________

E-Mail Address: (THIS E-MAIL ADDRESS WILL ONLY BE USED TO CONTACT YOU IF WE HAVE QUESTIONS REGARDING THIS ORDER, OTHER WISE WE WILL BE REQUIRED TO RETURN THE ORDER INCOMPLETE IF PROBLEMS ARISE)

E-mail ____________________________________________@______________________

Outside the USA Mail to: Name_________________________________________________

1st Address__________________________________________

2nd Address_________________________________________

City/Town_______________________________ Zip/Country Code___________________

Country____________________________

Telephone ( _____ ) ____________________________

Fax ( _____ )_________________________

EXPRESS MAILING PLEASE READ BELOW IMPORTANT!

NOTE: Check appropriate box for mailing. Please state by placing a check mark if you wish to WAIVER SIGNATURE when receiving EXPRESS MAIL! _______ Yes I wish to WAIVER SIGNATURE on my return mail, **NOTE** you will have to sign for document if this box is not checked! PLEASE WAIVER SIGNATURE WHEN SENDING EXPRESS MAIL TO ME, IF NOT IT COULD DELAY YOUR ORDER AS MUCH AS THREE DAYS!


SEAL PRICES AS FOLLOWS:
$100.00 PER 500 IS NORMAL HOWEVER PRICES VARY DUE TO PRICE CHANGES BY DISTRIBUTOR :

PLEASE LIST PAYMENT AMOUNTS ENCLOSED WITH ORDER BELOW:
$ ________ COST PER 500 ORDER: ( PRICE QUOTED BY ME BEFORE ORDER)
$ ________ OTHER PAYMENT, PLEASE STATE ________________________________________:
$ ________ SUB TOTAL AMOUNT ENCLOSE WITH ORDER:
$ ________ SUB TOTAL AMOUNT MINUS 20% DISCOUNT FOR CASH PAYMENT

** DO NOT INCLUDE POSTAGE IN THIS DISCOUNT OR IF PAYMENT IS MADE WITH MONEY ORDER **THIS DISCOUNT IS FOR US CASH CURRENCY ONLY **!!!

$________ NOW ADD POSTAGE COST TO THE SUB TOTAL ABOVE:
$________ FULL AMOUNT ENCLOSED WITH THIS ORDER:

NOTE: MULTIPLE ORDERS WILL BE MAIL TOGETHER IN ONE ENVELOPE UNLESS OTHERWISE SPECIFIED WHEN ORDERING


YOU MAY NOW PAY USING PAYPAL:

YOU WILL STILL NEED TO COMPLETE ORDER FORM AND SEND BY E-MAIL, LAND MAIL, OR FAX TO 1-502-955-6790

PLEASE PAY AMOUNT LISTED AS FULL AMOUNT ENCLOSED WITH ORDER AS LISTED ABOVE:

**** NOTE ORDERS WILL ONLY BE SHIPPED TO CONFIRMED PAYPAL ADDRESS WHEN PAYING WITH PAYPAL!! ***


LAST UP DATED: 04-10-2003

*** END OF APPLICATION FORM:***