OAT Seals Order Form

Send order to:
     Joan DuQuette, Customer Service Representative
     575 Main Street
     Suite 300
     Middletown, CT 06457
     Fax form to: 860-346-8586





Mailing Address:


City, State, Zip:


Phone Number:


Fax Number:


E-mail Address:


Select method of payment (in US dollars drawn on US bank)
checkbox Check/money order enclosed
(payable to "Choice")
checkboxSend invoice (term 30 days)
Charge my credit card:
checkboxAmerican Express

Card number:____________________________________


Signature: _________________________

Print name: _________________________

Telephone number:____________________

OAT Seal Digital File: $25.00 per use (i.e., ads, Web page, book cover)
Quantity to be produced:_______ x $25.00 = $_______

Seals: 15¢ per seal
Quantity:________ x 15¢ = $_______

Shipping & Handling = $ 7.50 (international orders may incur additional shipping fees)

Total = $______

FOR ACCOUNTING USE ONLY: 12-404-4109-3900