ACT Data Services, Inc.

Label Ordering Form

PLEASE ORDER IN QUANTITIES OF 1000 LABELS (250 SHEETS X 4 LABELS) @ $50/1000.

Quantity of Labels (1 = 1000):
Ship To

Company Name:

Address:

Address2:

City:

State: Zip:

Country:

Carrier: Account Number :

Authorized by :

Your email address where we send order confirmation :

Special Instructions: