Order Form

Please fill out a new form for each separate order. Complete all fields so that your order may be processed quickly and accurately.

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Contact Information

How would you like us to contact your with order confirmation?
If you do not receive a confirmation by the next business day please call 1-785-235-6868.

Company Name:
Contact Name:
Phone:
Fax:
E-mail:

Order Information

Form Name:
Quantity:
APS Previous Order #:
	Exact Repeat   OR
	Repeat with Changes
Changes to be Made or Special Instructions:
Start # (if needed):
Delivery Required:	Standard Rush Rush with Charges
Your PO # (if needed):

Shipping Information

We cannot ship to a Post Office Box.
Attention:
Street Address:
City:
State:
Zip:

Billing Information

(If different from Shipping Address.)
Attention:
Street Address:
City:
State:
Zip:
* To submit this form, please enter the characters you see in the image below: