Staples
TOWN OF WAPPINGER, NY
P.O. Box 324, Middlebush Road
Wappingers Falls, N.Y. 12590
Purch..e
Order No.
DO NOT WRITE IN THIS SOX
r
"I
Dille Vouch.r Receiv.d
FUND. APPROPRIATION AMOUNT
A
TOTAL
ABSTRACT NO. 1
PURCHASE ORDER & VOUCHER
CLAIMANT'S
N"ME AND
ADDRESS
STAPLES
L
-3
TERMS
VENDOR'S
REF. NO.
DATES QUANTITY DESCRIPTION OF MATERIALS OR SERVICES UNIT PRICE AMOUNT
Pg. 222 5 Boxesr #239293 Audio Cassettes 5/pk. XLII90 12 78 63 90
Pg. 423 2 Boxes r #298414 Avery Labels -Assorted 1/3 cut 5 28 10 56
Pg. 448 2 Rolls t #130740 Nylon Strapping Tape 6 83 13 66
Pg. 419 2 Boxes ~ #5160 White Mailing Labels-Avery
Pg. 583 1 Dz. #512452 Black Ballpoint Pens 3 97
Pg. 656 1 Box~ #515866 Rubber Bands 3H x 1/8" 5 99 5 99
Pg. 656 1 Box~ #515882 Rubber Bands 3i x 1/4" 5 99 5 99
Pg. 530 1BOX~ White Paper-Legal Sz. 8i X 14"
Pg. 307 1 BoxN #487494 Brown Kraft Envelopes 10. x 13. 54 26 54 26
Pg. 310 1Box~ #535104 Brown Kraft Envelopes 3 1/8 xSi" 29 88 29 88
Pg. 246 2 ~ #521880 Wite-Qut Extra Coverage 1 95 3 90
Pg. 246 4/Yv #377022 Liquid.Corr. Pen 2 94 11 76
Pg. 505 Pk. ~ #567882 Post-It Notes 2" x 2" 8 48 8 48
I
TOTAL
--
I. certify IlIIlllhe .bove .ccount in Ih. .mounl of $
is true .nd correct: thai the it.ms. ..rviaes. .nd disburs.m.nt. ch.rged _re rendered to or for the municipality on lhe d.... stated: lhat no part has been paid or satisfied: thai ta..s. from which the
municipality is ....mpl.d. "re not includ.d: .nd th.lthe .mounl cl.imed is .c due
8/2/2005
DATE
Town Clerk
TITLE
(SPACE BELOW FOR MUNICIPAL USE)
DEPARTMENT APPROVAL
The above services or materials were rendered. or
furnished to the municipality on the dates stated and the
charges are correct
APPROVAL FOR PAYMENT
This claim is approved paid from the appropriations indicated above
COMPTROLLER
DATE
AUTHORIZED OFFICIAL
DATE
TOWN OF WAPPINGER, NY
P.O. Box 324, Middlebush Road
Wappingers Falls, N.Y. 12590
Purchase
Order No.
DO NOT WRITE IN THIS BOX
r
-,
DIlte Voucher Received
FUND. APPROPRIATION AMOUNT
TOTAL
ABSTRACT NO. I
PURCHASE ORDER & VOUCHER
CLAIMANT'S
NAME AND
ADDRESS
STAPLES
L
-'
TERMS
VENDOR'S
REF. NO.
DATES QUANTITY DESCRIPTION OF MATERIALS OR SERVICES UNIT PRICE AMOUNT
Pg. 2U 4 Boxes //239293 Audio Cassettes 5/pk. XLII90 12 78 51 12
Pg. 64' 1 Box 11463681 Top-Loading Heavyweight Clear 26 99
Sheet Protectors
Pg. 42 1 Pk. //298414 Assorted Labels 1105215 5 28
Pg. 42 1 Pk. 11165803 Dark Red Labels AVE-FF3DR 4 83
Pg. 43E 2 Rolls 11130740 Nylon Str,apping Tape 18mn x 55 mn 6 38 12 76
Pg. 30e 1 Box 11187021 Brown Kraft Clasp Envelopes 9 x 12 18 40
Pg. 240 3 /1521906 Bic Wite-Out Correction Fluid 1 69 5 07
I
TOTAL 124.45
--
Gloria J. Morse
I. cerlily \het the above account in the amount 01 $
is tnJe and conect: thet the Items, services, and disbursements charged ....re rendered to or for the municipality on lhe dates sla'ed; thet no pert hes been paid or satislled: thet lexes, from which the
municipeHty is exempted, ere not included: end thet the amount claimed i. actually due
May 26, 2005
DATE
SIGNATURE
Town Clerk
TITLE
(SPACE BELOW FOR MUNICIPAL USE)
DEPARTMENT APPROVAL
The above services or materials were rendered. or
furnished to the municipality on the dates stated and the
charges are correct
APPROVAL FOR PAYMENT
This claim is approved paid from the appropriations indicated above
COMPTROLLER
DATE
AUTHORIZED OFFICIAL
DATE
Purchase
Order No.
TOWN OF WAPPINGER, NY
P,O. Box 324, Middlebush Road
Wappingers Falls, NY 12590
DO NOT WRITE IN THIS BOX
-,
Date Voucher Received
FUND. APPROPRIATION AMOUNT
TOTAL
ABSTRACT NO, 1
PURCHASE ORDER & VOUCHER
r
CLAIMANT'S
NAME AND
ADDRESS
STAPLES
L
I
--1
VENDOR'S
REF.NO.
TERMS
Brown Kra.ft Clasp Envelopes 9x12
UNIT PRICE AMOUNT
18 40
21 45
30 10
27 32
ey 21 72
3 97
10 S5
DATES
QUANTITY
DESCRIPTION OF MATERIALS OR SERVICES
pC" 300 1 Box U87021
1:>'
p€[. 300 1 Box #187039
Pg. 306 1 Box #535039
Pg. 326 1 Box #576938
Pg. 331 1 B O:::~ #489408
Pg. 583 1 Dz. #512452
Pg. 653 1 i?243550
Brown Kraft Clasp Envelopes lOx13
Manila Envelopes III x 13! J
Assorted Colors - Letter Size (100)
File Folders
Manila Top Tab File Fldrs. (Letter ff
1/3 Cut . //
Black Ballpoint PensV/
Okidata Microline 320 Turbo- 9 Pin
Cartridge Ribbon - Black J
OKI-52102001
&l~~s
I
133. 91 I
.:10
f;~31 IS7 7
I -;A .
TOTAL
Gloria J. Morse
I, certify that the above account in the amount of $
is lrue and correct; that the items, services. and disbursements charged were rendered to or for the municipality on the dates stated; that no part has been paid or satisfied; that taxes, from which the
municipality is exempted, are not included; and that the amount claimed is actually due
March 23, 2005
DATE
Town Clerk
TITLE
SIGNATURE
(SPACE BELOW FOR MUNICIPAL USE)
DEPARTMENT APPROVAL
The above services or materials were rendered or
furnished to the municipality on the dates stated and the
charges are correct
APPROVAL FOR PAYMENT
This claim is approved paid from the appropriations indicated above
DATE
AUTHORIZED OFFICIAL
DATE
COMPTROLLER
TOWN OF WAPPINGER, NY
P.O. Box 324, Middlebush Road
Wappingers Falls, N.Y. 12590
/..,/J .
0~
/"
CLAIMANT'S
NAME AND
ADDRESS
STAPLES
I~~
~,~~~.
...., JL~
6>1~
NT
PURCHASE ORDER & VOUCHER
r
L
..J
TERMS
K!:I-,NU,
DATES QUANTITY DESCRIPTION OF MATERIALS OR SERVICES UNIT PRICE AMOUNT
Pg. 222 5 Boxes #239293 Audio Cassettes 5/pk. XLII90 12 78 63 90
Pg. 423 2 Boxes #298414 Avery Labels -Assorted 1/3 cut 5 28 10 56
Pg. 448 2 Rolls #130740 Nylon Strapping Tape 6 83 13 66
Pg. 419 2 Boxes #5160 White Mailing Labels-Avery
Pg. 583 1 Dz. #512452 Black Ballpoint Pens 3 97
Pg. 656 1 Box #515866 Rubber Bands 3H x 1/8" 5 99 5 99
Pg. 656 1 Box #515882 Rubber Bands 3ix 1/4" 5 99 5 99
Pg. 530 1 Box White Paper-Legal Sz. 8i X 14"
Pg. 307 1 Box #487494 Brown Kraft Envelopes 10. x 13. 54 26 54 26
Pg. 310 1 Box #535104 Brown Kraft Envelopes 3 1/8 xSi" 29 88 29 88
Pg. 246 2 #521880 Wite-Dut Extra Coverage 1 95 3 90
Pg. 246 4 #371022 Liquid" ,Corr. Pen 2 94 11 76
I
TOTAL
--
I. certify that ttle above account in the amount 01 $
is true and conect: that the IIams. services. and dilbulHments charged W8f8 ..ndared to or tor the municipality on the da..s stated; that no part has been paid or salislled; that t..el. from which the
municipality is exampted. are not included: and that the amount claimed is actullly due
8/2/2005
DATE
SIGNATURE
Town Clerk
TITLE
(SPACE BELOW FOR MUNICIPAL USE)
DEPARTMENT APPROVAL
The above services or materials were rendered. or
furnished to the municipality on the dates stated and the
charges are correct
APPROVAL FOR PAYMENT
This claim is approved paid from the appropriations indicated above
COMPTROLLER
DATE
AUTHORIZED OFFICIAL
DATE
TOWN OF WAPPINGER, NY
P.O. Box 324, Middlebush Road
Wappingers Falls, NY. 12590
Purchase
Order No.
DO NOT WRITE IN THIS BOX
r
--,
Date Voucher Received
FUND - APPROPRIATION AMOUNT
TOTAL
ABSTRACT NO. I
PURCHASE ORDER & VOUCHER
CLAIMANT'S
NAME AND
ADDRESS
STAPLES
L
-.J
TERMS
VENDOR'S
REF NO.
DATES QUANTITY DESCRIPTION OF MATERIALS OR SERVICES UNIT PRICE AMOUNT
Pg. 216 4 Boxes /1239293 Audio Cassettes 5/pk. XLII90 12 78 51 12
I
Pg. 642 1 Box 11463681 Top-Loading Heavyweight Clear 26 99
Sheet Protectors
Pg. 423 1 Pk. It298414 Assorted Labels Ito5215 I 5 28
I
Pg. 423 1 Pk. 1H65803 Dark Red Labels AVE-FF3DR 4 83
Pg. 438 2 Rolls 1H30740 Nylon Strapping Tape 18nm x 55 nm 6 38 12 76
Pg. 300 1 Box 1H87021 Brown Kraft Clasp Envelopes 9 x 12 18 40
Pg. 245 3 11521906 Bic Wite-Out Correction Fluid 1 69 5 07
~~/l
\) ,/
vi i
//
l I
TOTAL /; #. I{~,.I
I. certify that the above account in the amount of $
is true and correct: that the items, services, and disbursements charged were rendered to or for the municipality on the dates stated: that no part has been paid or satisfied; that taxes. from which the
municipality is exempted. are not included; and that the amount claimed is actually due
DATE
SIGNATURE
TITLE
(SPACE BELOW FOR MUNICIPAL USE)
DEPARTMENT APPROVAL
The above services or materials were rendered, or
furnished to the municipality on the dates stated and the
charges are correct
II
APPROVAL FOR PAYMENT
This claim is approved paid from the appropriations indicated above
COMPTROLLER
DATE
AUTHORIZED OFFICIAL
DATE
~ .
..
TOWN OF WAPPINGER. NY
P.O. Box 324, Middlebush Road
Wappingers Falls, N.Y. 12590
PURCHASE ORDER & VOUCHER
fSWLsJ M fMeJ.S 4Iv'Ar1Jl\6~ -,
CLAIMANT'S!en- R. 6(!. 'if5"1 0 ~
NAMEAND 00 ~ 3A85t
ADDRESS f '-' ~
~M(~, ~T fXt/So~ot5'1 ..J
TERMS
Purcha.e
Order No.
DO NOT WRITE IN THIS SOX
Dale Voucher Received
FUND. APPROPRIATION AMOUNT
.----
TOTAL
ABSTRACT NO. I
VENDOR'S
REF. NO.
~
DATES QUANTITY DESCRIPTION OF MATERIALS OR SERVICES UNIT -
.
'1/C,IDJ a. CuST ~ IN( JTAtrlP ~
0
15/1{, )(d.. -3\N .
~
I
TOTAL Lf:J.100
--
I, 'J I1-t f\ C , ~ ~ certify that the above account in the amount of S tfJ. . (, ()
is lrue and conect: that tne ilems. ..Nices. end di.bu..ements cherged ...... ..ndered to or lor lhe municipality on the dales slaled: lhat no part has been paid or ..ti.lled: that ...... from which tne
munlcipallty~s e.empled, e.. nol included; end lnet the emount claimed is actuelly due
.1/.!Ib( DATE
1-
c.~
51 ATURE
~ eL.UJc
TITLE
(SPACE BELOW FOR MUNICIPAL USE)
DEPARTMENT APPROVAL
The above services or materials were rendered. or
furnished to the municipality on the dates stated and the
charges are correct
DATE
AUTHORIZED OFFICIAL
APPROVAL FOR PAYMENT
This claim is approved paid from the appropriations indicated above
DATE
COMPTROLLER
S1APtES
INVOICE
Staples Business Advantage, 500 Staples Drive, Framingham, MA 01702 Federal ID #:04-2896127
Bill To: Ship To:
TOWN OF WAPPINGERS FALLS
~ERRY TERWILLIGER
20 MIDDLEBUSH RD
CONTRACT #PC55202
WAPPINGERS FALLS, NY 12590
RECEIVED
TOWN OF WAPPINGERS FALLS
ATTN: VINCENT FABIAN:!
20 MIDDLEBUSH RD
WAPPINGERS FALLS, NY 12590
JUt 0 li 2005
~ ~ ~lL-O~ o~
~ {So.,,~ at ~~\t~OI'\
Bill to Account: 1002720
COMPTROlLER'S OFFICE
TOWN OF WAPPINGER
Ship to Account: 0-001
Budget Ctr:
P 0 Number: 061005
Ordered by: VINCENT
3057721031
69672626-000-001
6/10/05
2
21.30
42.60
Backorder of 0069672626
Customer Service irlCJ.liries # 800-724-0110 AIR irlCJ.liries # 800-699-5812 Page:
Make checks payable to Staples Business Advantage, Dept ROC 85102 PO Box 30851, Hartford CT 06150-0851
0001351-0000520-0000002
r{:to...,...'.......:.:,...:EN............,,:,..SOR,.....,....'...:.........',."..,..,.!!,........:..,::..,.~...:..:...,ROP,.,.,,:,.,,:,.,....,.:......,.:.:.....~.:....'....,....,...'..:.::,..,...CR,:iEI#1Wj~Jjl#:ij:R,b.::ijMtiJ$iilj$#MtfQtil:ijm}(.C:Iijjj#J!;fl4~)::::::::::::::"':""""
:.:-:-:-:.:-:.:.;.;.:.;.;,;,:,:,:,:".:.'.:-:.:-:-:-:.:-:.'-:.:.;.;.;.;.:.;.;.:.......:.:.;.:.;.:-:..............;..-:-:...................;...............................................................................................................-......................,.................................,.
Customer Service irlCJ.liries # 800-724-0110
AIR intJ.liries # 800-699-5812
mil
Pl ease send payment to:
Staples Business Advantage
Dept ROC 85102
PO Box 30851
Hartford, CT 06150-0851
RCH3D57721D31DDDDD426D5
==
==
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
STAPlES
TEL 1-800-308-0331
FAX 1-800-308-0351
Photocopy This Form For Future Use.
Please Print Neatly
Ship To
Address:
Credit Card #:
PLEASE CHECK APPROPRIATE BOX
STAMPS & DATERS
Check One
~e-Inked
Stamp
I
I
o Rubber ~
Stamp ~
o Date/Number ~
Stamp ;
~elf-Inking
Stamp
o Refill Ink
Item #
Quantity
Mf~-Na. ;L
IV ~~
Ink Colors (If Required)
Bla~ Red Blue Green Violet
IV 0 0 0 0
o 2 Color Dater - Red Date & Blue Text
Type Information & Layout
o REG BLOCK 0 ROMAN SERIF
IIiBOLD
~
ea
o Border
liiMatch Sample
Specify Stamp Brand or Model Color(s)
o Rubber'Stamp Ink Pad Specify Stamp Brand or Model
o Dater or Self-Inker
Replacement Pad
Color(s)
rNlfffONAL I
~@IC#
Internal Use Only
Staples Internal PO #
Account #
j(J 1u.r'lCf
PO#
Ship To #
Department Name
Cost Center
Fax:
Desk Sign
~
o With Holder
o Plate Only
o Holder Only
Item #
{"Q
(~~~ J,97
(31~) ~q 7
- ).7'1
-t.jS-5'&
Ext.
Name On Card
Exp. Date
SIGNS & BADGES
SEALS
Embossers
Wall Sign
~
Name Badges
~
D..
\fiIi
o Desk Seal
o Pocket Seal
o Upper/Lower
o ALL CAPS
Item
o With Holder
o Plate Only
o Holder Only
o Standard
o Uniform
o Logo
Quantity
Size (Height x Width)
x
#
Quantity _
Color # Holder Color Typeface Information & Layout
o REG BLOCK o ROMAN SERIF o BOLD
Badge Fasteners Wall Sign Mountings
o Safety Pin Back o 2-Sided Tape o Upper/Lower o Centered_ o Beveled Edges
o Military Clutch o Screw Holes
o Swivel Bulldog Clip o VELCRO" Strips o ALL CAPS o Flush Left o Rounded Corners
o Pocket Insert o Magnetic Tape
o Magnetic Bar o Suction Cup
SPECIAL INSTRUCTIONS
'* r J~-e... Ye.f> )Al-€-, b Iv r' i t.'A..-
Mo ~ <,)J;S no..m ~ WI'-i-h
+htt.+-oF -JoHN e,
M AS I 13. r soN
pv-l- h; 5 no. yYUL I' n .J-~
s ~ fYI..SL.. f J~ -? j-hq+
{; ;0{/ '^ IS llVJUL W4..S ,,1hfUlk-
COPY DESIRED - Please Print Neatly or Attach Sample
PAY TO THE ORDER OF
BANK OF AMERICA
TOWN OF WAPPINGER
TOWN CLERK
9400064928
~,
t,
... ,,;:::.
J:hn C. N1 ASTE~5oN
ORDERING TIPS
Order One Product Per Form - Multiples of the same item number may be ordered on one form. Attach
list of names or text if necessary.
~ - Will be ALL CAPS, centered, regular block with black ink if layout is not clear.
Sianalures/Artwork - Attach clean black & white copy on unlined paper to order
form, Faxing is not recommended, as images are often inconsistent and distorted.
Mii!.12 - Staples Stamp Department P.O. Box 356, S. Easton, MA 02375
Samale Slama Imaresslons . Will be matched as closely as possible.
i -
.".
TOWN OF WAPPINGER. NY
P.O. Box 324, Middlebush Road
Wappingers Falls, N.Y. 12590
Purcha.e
Order No.
DO NOT WRITE IN THIS BOX
rS"TAPLES 6vs"J~55 ~V~
CLAIMANT'S h,..n+ J0c.. %51 Od.
NAME AND (}-r
ADDRESS rO be<< 3,,'5'
UA/{TFtK(.b cr 0",'50 - 08'51
L I
--,
Dllte Voucher Received
FUND. APPROPRIATION AMOUNT
TOTAL
ABSTRACT NO. 1
PURCHASE ORDER & VOUCHER
..J
TERMS
VENDOR'S
REF.NO.
DATES QUANTITY DESCRIPTION OF MATERIALS OR SERVICES UNIT PRICE AMOUNT
'1J"foS- ~ SiAnl f pRt- INk AoJS 71tnf C IJSTlJI1 3" &:'0 13 :b
\
I
TOTAL 13.Jo
--
I. :r ~ ( IVlItb ~ celtlly that the above account in the amount 01 $ '73 · d 0
IS true and correct: that the IIams. services. and disbursements charged _re rendered lQ or for the munlclpatity on the date. staled: that no part has been paid or ..Uslled: that taxe.. Irom which the
;r:;:z:~_OW~h'_"'1{~ ~>>~ (~
. (SPACE BELOW FOR MUNICIPAL USE)
DEPARTMENT APPROVAL
The above services or materials were rendered. or
furnished to the municipality on the dates stated and the
charges are correct
APPROVAL FOR PAYMENT
This claim is approved paid from the appropriations indicated above
DATE
AUTHORIZED OFFICIAL
DATE
COMPTROLLER
./
-
S1APtES
:;fNV-DICE:OATE::: <,:0 '
6 30/05
:~PL:EA' . ".. :.:AY.;.; ..
7/30/05
<:'::':':':':':':':'::;}}){{{ll'il'it' l: ". E;}. 'MBER:)
RCH 1010549 3057742506
. "':'::"';}}}';:;::};;:;;'};;;;}))){ ,,)ANt .UNTJ)U .... ......
Net 30 Da 5 73.20
INVOICE
Staples Business Advantage. 500 Staples Drive. Framil'1Jham. MA 01702 Federal ID #:04-2896127
Bill To: Ship To:
TOWN OF WAPPINGERS FALLS
JERRY TERWILLIGER
20 MIDDLEBUSH RD
CONTRACT #PC55202
WAPPINGERS FALLS. NY 12590
RECEIVED
TOWN OF WAPPINGERS FALLS
ATTN: VINCENT FABIAN)
20 MIDDLEBUSH RD
WAPPINGERS FALLS. NY 12590
JUL 0 5 2005
Bill to Account: 1002720
COMPTROLLER'S OFFICE
TnWN OF WAPPINGER
Si' na,V"-l.- Ship to Account:
b.:r:- Mo.dtACjQvo i ce Number:
Order:
Order Date:
3057742506
69744965-000-001
6/16/05
0-001
Budget Ctr:
P D Number:
Ordered by:
573903
0022CYl
STAMP PRE INK ACUSTAMP CUSTOM
EA
2
36.60
73.20
2
Backorder of 0069744965
CUstomer Serviceil1tJ.liries # 800-724-0110 AIR il1tJ.liries # 800-699-5812 Page:
Make checks payable to Staples Business Advantage. Dept ROC 85102 PO Box 30851. Hartford CT 06150-0851
0001743-0000638-0000002
tU'JB'::~g::::Bf!l:::ml~~f.:t[g~M~i~f::::.:)~~::;ffl~$::~~~j~~@i::!i:ijf.{::pi~ii:m;'::::::::1
CUstomer Service il1tJ.liries # 800-724-0110
AIR il1tJ.liries # 800-699-5812
mil
Please send payment to:
Staples Business Advantage
Dept ROC 85102
PO Box 30851
Hartford. CT 06150-0851
INVOICEOATE) n .n
... ......................
...-..-...................
. . . . . . . . . . . . . . . . . . . . . . . . .
. . ... . . - ......... . .........
J'oW 'AS): ',:, :,:'::::8:, .'} ::}: . : :::::::::::::::::::::::::::::'::;::::::: ... n n
7 30 05 Net 30 Da
pijgA$g:EJ\l1$t{:AMWNr::f!i.\Ml).Hi ':':.,::' .:.':
RCH305774250b0000073209
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STAPlES
TEL 1-800-308-0331
FAX 1-800-308-0351
Photocopy This Form For Future Use.
(B1fttONRL'
~@IC#
Staples Internal PO #
Please Print Neatly
Company
Name: ..........
/ CLL!O of-We: .ef
Ship To '') ^ 0\' P (J
Address: 0<0 ^~ idlt:l Q... ~ iJ5h l'<'(l&X-
Wo..ffJi,()~e.(S re-d\ S
Nau Yor k- }A~qD
t )>1)0 ~r Date
Account #
PO #
/0 loS""t)c;
Ship To #
Department Name
Cost Center
Contact Name:
Phone:
.~~ ~tYl.rt.<L
C7
-2711
is'/S'l ;;)C, 7 - LfS-58
~. ()(Cil+ ~~ b io. tv 0
(81~l
Ext.
Fax:
Il Please Bill My Account
o Please Bill My Credit Card
Credit Card #:
Name On Card
Exp. Date
PLEASE CHECK APPROPRIATE BOX
STAMPS & DATERS
~
SIGNS & BADGES SEALS
Desk Sign Wall Sign Name Badges Embossers
~ \fiii ~
~ D..
o With Holder o With Holder o Standard o Desk Seal
o Plate Only o Plate Only o Uniform o Pocket Seal
o Holder Only o Holder Only o Logo o Upper/Lower
o ALL CAPS
Item # Quantity Size (Height x Width) Item
#
X
Quantity _
Check One
Item #
Quantity
o Pre-Inked I
Stamp
o Sell-Inking !
Stamp
i1:.bber ~
Stamp
Ink Colors (If Required)
Blac)l Red Blue Green Violet
g' 0 0 0 0
o 2 Color Dater - Red Date & Blue Text
Type Information & Layout
o Date/Number ~
Stamp ~
o REG BLOCK
o BOLD
o ROMAN SERIF
dSCript
o Upper/Lower Centered
o ALL CAPS
o Border
mt'Match Sample
o Rubber Stamp Ink Pad Specify Stamp Brand or Model
o Dater or Sell-Inker
Replacement Pad
Color(s)
Color # Holder Color Typeface Information & Layout
o REG BLOCK o ROMAN SERIF o BOLO
Badge Fasteners Wall Sign Mountings
o Safely Pin Back o 2-Sided Tape o Upper/Lower o Centered o Beveled Edges
o Military Clutch o Screw Holes \
o Swivel Bulldog Clip o VELCRO" Strips o ALL CAPS o Flush Left o Rounded Corners
o Pocket Insert o Magnetic Tape
o Magnetic Bar o Suction Cup
o Refill Ink
~ Specify Stamp Brand or Model
~
Color(s)
COPY DESIRED - Please Print Neatly or Attach Sample
SPECIAL INSTRUCTIONS
./ .
jLcn~.
ORDERING TIPS
Order One Product Per Form - Multiples of the same item number may be ordered on one fomn. Attach
lis\ of names or text if necessary.
~ - Will be ALL CAPS, centered, regular block with black ink if layout is nol clear.
Sionatures/Artwork - Attach clean black & white copy on unlined paper to order
fomn. Faxing is not recommended, as images are often inconsistent and distorted.
Mail To . Staples Stamp Department P.O. Box 356, S. Easton, MA 02375
Samete Stame Imeressions - Will be matched as closely as possible.
.:J
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