------------------------------------- ------------ -------- ------- ----------
  **Contact Name:**                     Email:                        Date:
                                                                           

  Telephone:                            Fax:                          

  Shipping Address:                                                   

                                                                      

  City:                                              State:   Zip:    
                                                                      
  ------------------------------------- ------------ -------- ------- ----------

+-------------------------------------------------------+--------------+
| PURCHASE CARD NUMBER MUST                             |              |
|                                                       |              |
| ACCOMPANY ORDER                                       |              |
+-------------------------------------------------------+--------------+
| IMPAC Card Number                                     | Exp. Date    |
|                                                       |              |
|                                                       |              |
+-------------------------------------------------------+--------------+
| Print Cardholder Name                                 |              |
|                                                       |              |
|                                                       |              |
+-------------------------------------------------------+--------------+
| Authorized Signature of Cardholder                    |              |
+-------------------------------------------------------+--------------+

Instructions for Ordering Multiple Names

1\. Complete "Section A" on the first order form.

2\. Attach an additional order form for each additional name.

3\. On each additional form fill in the Contact Name in\
"Section A" and completely fill out "Section B."

**TOTALS FOR THIS ORDER**

+-----------+------+---------+---------+---------+---------+----------+
| ITEM      | BOX  | FRONT   |         | MISSION |         | SUB-     |
|           | QTY  | ONLY    |         | STMT ON |         |          |
| NUMBER    |      |         |         | BACK    |         | TOTALS   |
+-----------+------+---------+---------+---------+---------+----------+
|           |      | Unit    | No. of  | Unit    | No. of  |          |
|           |      | Cost    | Boxes   | Cost    | Boxes   |          |
+-----------+------+---------+---------+---------+---------+----------+
| BC0902    | 250  | \$26.06 |         | \$35.18 |         |          |
+-----------+------+---------+---------+---------+---------+----------+
| BC0905    | 500  | \$33.95 |         | \$45.84 |         |          |
+-----------+------+---------+---------+---------+---------+----------+
| BC0910    | 1000 | \$46.62 |         | \$62.94 |         |          |
+-----------+------+---------+---------+---------+---------+----------+
|           |      |         |         |         | TOTAL   |          |
|           |      |         |         |         | COST    |          |
+-----------+------+---------+---------+---------+---------+----------+

![](media/image2.wmf){width="0.39448818897637794in"
height="0.38070866141732285in"}*Business Cards contain 30% PCW which
meets Federal Procurement Guildelines.*

Type or Print Clearly all information AS IT SHOULD APPEAR ON CARD

![](media/image3.jpeg){width="3.5597222222222222in"
height="2.053472222222222in"}

+------------------------------+---------------------------------------+
| SPECIFIC INFORMATION FOR     |                                       |
| THIS NAME\                   |                                       |
| (If no selection is made you |                                       |
| will receive 250 1-sided     |                                       |
| cards)                       |                                       |
+------------------------------+---------------------------------------+
| 250 (BC0902)                 | 1 Sided                               |
|                              |                                       |
| 500 (BC0905)                 | Mission Statement                     |
|                              |                                       |
| 1000 (BC0910)                | on Back                               |
+------------------------------+---------------------------------------+

Logo is 2-Color Thermography. All Text is Flat Black Ink.

Cards will be formatted per sample,

to meet NRCS's graphic standards requirements.

  --------- --------------------------------- ------------- -------------------- --
            1\. Name:                                                            

            2\. Title:                                                           

            3\. Division:                                                        

            4\. Address:                                                         

  5\. City:                                   State:        Zip:                 
                                                                                 

  6\.                                                                            
  Voice:                                                                         
                                                                                 

  FAX:                                                                           
                                                                                 

  7\.                                                                            
  E-mail:                                                                        
                                                                                 
  --------- --------------------------------- ------------- -------------------- --

  -----------------------------------------------------------------------

  Check your order carefully. We will follow your copy exactly within
  graphic standard parameters. We cannot be held responsible for unclear,
  illegible copy or customer errors on the order form. If our mistake,
  you have 30 days from the date we ship your order to contact us for
  reprinting. Changes requested after we receive your order may result in
  additional processing charges. CANCELLED ORDERS ARE SUBJECT TO CHARGE.
  -----------------------------------------------------------------------