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Positive Promotions Order Toll-Free
15 Gilpin Avenue * PO Box 18021 Phone: 800-635-2666 Fax: 800-635-2329
Hauppage, NY 11788-8821
www.positivepromotions.com
PURCHASE ORDER FORM FOR DATE: [[date]]
www.positivepromotions.com
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BILL TO: SHIP TO:
____________________________________ ____________________________________
Organization/Facility Organization/Facility
____________________________________ ____________________________________
First Name Last Name First Name Last Name
____________________________________ ____________________________________
Street Address Street Address (Do not use a PO Box)
____________________________________ ____________________________________
Street Address (line 2) Street Address (line 2)
____________________________________ ____________________________________
City State ZIP City State ZIP
____________________________________ ____________________________________
Country Phone Ext.
____________________________________ ____________________________________
Ordered By E-mail
____________________________________ ____________________________________
Authorized Signature (Required with Order) Fax
PAYMENT:
_____ Check Enclosed: $_________________ (Make Payable to Positive Promotions)
_____ Credit Card: ___VISA ___MasterCard ___AMEX
Credit Card Number: |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|
Expiration Date: ____/____ ______________________________________
Exact name as printed on card
_____ Bill me later
_____ Purchase Order Enclosed: P.O. No: _______________________________________
Prepayment will speed your order through our credit department
Shipping Method (if other than Standard): ___2-Day ___Next Day
THANK YOU FOR ORDERING VIA POSITIVEPROMOTIONS.COM
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