P.O. Box 1897 * Kennesaw, GA  30156

(Delivery) 5919 Lake Acworth Drive * Acworth, GA  30101

E-mail: nls@nlsspecialties.com * www.NLSSpecialties.com

(770) 422-7867    * Voice Mail (770) 529-6242    * Fax (770) 421-9473    *Fax (770) 529-3055

Fill in this order form for all orders.  Use black ink if faxing.

Has church ordered previously?  yes ____ no____   Order Date  _______________   Date Needed _______________

Person Ordering  ______________________________________________   Position _______________________

Church Phone  __________________________________ext._______      Church Fax ________________________

Day Phone _______________________________________ext.________    Is that # Work _____ or Home_____?

E-mail address  ________________________________________________

We need Church information before processing any order.  We prefer shipping to the Church.

Church Name  _______________________________________________________________________________

Church Delivery Address    

    Street Address   __________________________________________________________________________

        City  _____________________________________     State  _____________________     Zip ________

Church Billing Address 

    Street Address   __________________________________________________________________________

        City  _____________________________________     State  _____________________     Zip ________

Ship to if different than Church: Home  _____ or  Work  _____ 

        Street Address   __________________________________________________________________________

        City  _____________________________________     State  _____________________     Zip ________

 

Method of Payment (Check one):

    ___Church Purchase Order # _________                ___Sent Check # ___________                ___Bill to Church   

     ___Charge Credit Card      ___  Personal          or              ___  Church

                                                   ___  Visa                 or              ___  Mastercard

    Card#  _________________________________________            Exp Date _________________

    If Personal Credit Card used,  give name of Person on Credit Card    _____________________________________

    DAYTIME phone # of person on Credit Card    ____________________________________________________

    Billing address for Credit Card holder Authorization    Street # ONLY______________________   Zip __________

Tax Exempt #  _____________________________

If you are ordering two or more stock items EX: Kiddie Keepers and Stock Diaper Bag Tags then add one shipping charge to the total order.  Stock shipments are totaled                                             and shipped together from our office.

Choose from stock or custom bracelets:

Stock Disposable Tyvek Bracelet Custom Printed Disposable Tyvek Bracelet
Price Per Bracelet Quantity Total Price Price Per Bracelet Quantity Total Price

Assorted Colors:

(with adhesive on stub) 

1-249 @ $0.25

250-499 @ $0.15

500-999 @ $0.12

1000-4999 @ $0.10

5000-9999 @ $0.08

10000 @$.07

 

500 Per Color: (Adhesive on stub)

500 @ $0.08

1000 @ $0.07

5000 @ $0.06

10000 @ $0.05

 

 

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Minimum 1000@ $0.15

5000 @ $0.09

10000 @ $0.07

(1000 per color)

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Color: .

Set-Up Charge:

$0.00 

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Colors Available: With Adhesive on stub- aqua, lime, orange, pink, yellow, purple, blue, red, white.   Color:  .
Imprint:

 

Additional

Items/Description

Imprint

Item Color

Quantity

$ Each

$ Total

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Shipping Tax * (GA Customers) on products only    County ___________Tax% ___________

GA Sales Tax

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Stock SHIPPING SCHEDULE: General Shipping for items shipped from our in-stock products.

$0-25 =$7.50   $26-50 =$8.00   $51-100 =$8.50   $101-150 =$9.50   $151-200 =$10.50

Add $1 for every $50 over $200 (Some items may be more / EX. mugs, squeeze bottles, etc.)

Add approximately $10 for UPS 3 day select / $15 for UPS blue 2 day service / $20 for UPS red standard overnight (if heavy more will be added).

SHIPPING

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TOTAL 

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We consider it a blessing to be a part of your ministry!!!

Jamie Cardell, Pam Reeves, Christy Godfrey, Deanna Burkhardt and Joy Carlisle