Please choose from the following: Quote New Order Exact Re-run Re-run with changes

Company Name:

First Name:

Last Name:

Address:

City:

State: AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MO MN MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VT VA WA WI WV WY Zip:

Phone:

Fax:

Email:

Purchase Order #:

How will Crossroads Press, Inc. be receiving the artwork for your job? Black & White hard copy PC Disk Mac disk Email PC file Email Mac File Film Furnished

What kind of proof will you require? Faxed Email Color Proof (film only)

Due date for delivery:

Is this date flexible? Yes No By a day or 2

Please write a brief description of the job you are requesting:

Quantity needed: Finished size:

Paper: (specify color, weight, finish, and paper name)

Number of sides to be printed per sheet: One side Two sides

Number of color inks: One color 2 color 3 color 4 color other

Colors to be used:

Are there any Bleeds on this sheet No Yes How many bleeds? 1 side 2 sides 3 sides all 4 sides

What bindery procedures are needed to complete your job? Please mark all that apply.

Deliver UPS FedEx Messenger Best Way

Are the billing and shipping addresses the same? yes no

Shipping instructions:

Additional comments or instructions: