Contact Name: - United States Department of Justice



|Contact Name: |      |Tel: |      |Date: |      |

|Agency Name: |      |Fax: |      |E-mail: |      |

|Shipping Contact & Address: |      |

|Orders ship UPS Ground or FedEx Ground unless other |      |

|arrangements are made | |

|Payment Method | | |Not all logos available in embossed gold foil – please call to confirm. |

|Credit Card Number |Expiration Date | |Style Selection |A B C D E |

|      |      | |(A, B, C, D, E): |Custom (add $30.00)       |

| | | |Name of Template if Known: |      |

|Print |      | |No. of Sides : | 1 side 2 sides * |

|Cardholder Name: | | |(Provide sample for 2nd side) | |

|Signature of Cardholder | |Logo: | Foil Printed Custom |

| | |(Foil Styles A or B Only) | |

|Check/Money Order # |      | |Color: | Black Blue |

|Purchase Order # |      | |Quantity: | 250 500 1000 |

|(Minimum order value $50) | | | | |

|Billing Address |      | |Braille/Custom/Overseas Shipping|      |

|($50 minimum) | | |fee(s): | |

| |      | |Cost: |      |

Business Cards have 30% PCW / 50% Recycled which meets Federal Procurement guidelines.

Instructions for Braille Cards Braille Option

Braille text is limited to four lines of 13 characters each 250 Braille One Side $25.00

In using Braille there is no punctuation or capitalization 500 Braille One Side $50.00

Enter Braille info here: Sample: 1000 Braille One Side $100.00

|1. |      |

|2. |      |

|3. |      |

|4. |      |

john smith

dept of ed * Information for 2nd Side (or attach sheet if needed)

voc rehab      

202-222-2222

| |All caps, small caps, lowercase based on style selected. |

| | |

|Type or Print Information | |

|      | |      |Address Line 1: |      |

|Logo/Seal to appear on card | |2nd logo (for Style D only) |Address Line 2: |      |

|(Attach Sample if possible) | | | | |

|*Agency Heading: |      |Address Line 3: |      |

| | |(N/A for style C) | |

|Subheadi|      |City: |      |

|ng (if | | | |

|any): | | | |

|Title: |      |Fax: |      |

|Title Line 2 if needed: |      |E-mail: |      |

|(on same line as Title for style C if| | | |

|space permits) | | | |

|Division, Branch, Office, etc: |      |Other (specify):|      |

|(on same line as Title for style C if| | | |

|space permits) | | | |

*U.S. Department of Justice Bureaus must have “U.S. Department of Justice” as the Main Agency as per the U.S. Department of Justice Graphic Standards Manual.

For additional styles –call 1-800-799-0402 for more information. ** Information to appear on card back: We will match front of card. Attach separate sheet if needed.

|NOTE: Please review order forms before submission. Remake requests will be at full cost to the customer if due to unclear orders or customer error. We will honor all|

|remake requests due to errors on our part if notified within 30 days of shipment. All email addresses set using lower case. All States set using 2 letter code. |

|Cancelled orders subject to charge. |

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A

B

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Envision Business Cards

2050 S. Edwards | Wichita, KS 67213

Toll Free: 1.877.229.8466

Fax: 316.440.6427

Web:

Government

Business Card Order Form

Schedule # 75IIB

Contract # GS-00F-0001K SIN J752-1

Please Type or Print

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