Check Order Form

Use this simple order form to e-mail us check orders.  If this is a new order or with any type of changes, please fax a copy to 610-328-3677. 
See Additional Instructions at the bottom of this page!

Please provide the following contact information:

First Name
Last Name
Organization
Mail Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
FAX
E-mail

Please provide your account information:

Account #

   Check here if this is your first order with Shield Business

Please provide the following ordering information:

BILLING
Purchase Order #
SHIPPING
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country

Please provide the following additional ordering information:

QTY DESCRIPTION

SELECT FORMAT OF CHECK:
SELECT STYLE OF CHECK:
SELECT TYPE OF CHECK:

Product information:

Software
Operating System
Product Code

This order is:

Starting #

Check Colors: 

Would you like a Logo ?    Yes No  

Do you have any Special Instructions:


Additional Instructions:
  1. When ordering checks, you are responsible to verify that the bank information and account number are current.
  2. If this is a new order or with any changes, please fax us a copy of the check.
  3. Please make sure you give us a contact name and phone in case we have any questions or need additional information.
  4. If you need a logo other then those listed in the box above, please send us a clean copy for us to duplicate.  You may also e-mail the logo:  shieldbsy@aol.com 

© 2004 Shield Business Systems, Ltd.  All rights reserved.

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