NAVSEA Name Tag Order Form & Fax Cover Sheet

FROM:

DATE: ______________________

SHIP TO: ____________________________________________ DSN: ____________

CONTACT: __________________________________________ CODE: __________

ADDRESS: ____________________________________________________________

_____________________________________________________________________

PHONE NO: _____________________ FAX NO: ___________________________

TO:

VENDOR: All Star Nametags

CONTACT: Jeff Johnson

PHONE NO: 1-800-852-1294             FAX NO: 972-923-1176

NO. OF PAGES (including cover sheet): ___________________________________

FASTENERS (circle one):           clutch pins (std)           magnets           mixed

REMARKS: ___________________________________________________________

______________________________________________________________________

PAYMENT INFORMATION

CREDIT CARD TYPE (circle one): MasterCard or Visa

CREDIT CARD NO.: _____________________________ EXP. DATE: __________

CC Verification Code: _________

C.C. BILLING ADDRESS: ______________________________________________

CITY: ______________________________ STATE: _______ ZIP: _____________