Phone: (800) 749-6863   Fax: (800) 727-4187 621 Indeneer Drive    Kernersville, NC 27284

Billing Information
Your Customer #
Company
Address
City
State		Zip
Tax Exempt # (if applicable)
Contact Information
First Name		Last Name
Title
Phone		Secondary Phone
Fax		Email
Would You Like to Receive Emails?
Order Information
Order Type	Contract Embroidery Digitizing Edit Design Screenprinting
Your Purchase Order Number
Salesperson
Shipping Information
Requested Ship Date		Date Order Must Ship
Company
Address
City
State		Zip
Shipping Method	UPS Ground UPS 2nd Day UPS Overnight Customer Pickup Other
Design Information
Design Type	Custom Embroidery
Title 1
Location 1
Colors 1
Title 2
Location 2
Colors 2
Request a Proof?
Notes
Additional Comments or Instructions