CLP SPECIALTY ADVERTISING & PROMOTIONS
ORDER FORM
(PRINT AND FAX ORDERS: 1-510-336-3208)

DELIVERY ADDRESS



FIRST NAME:
___________________________________ LAST NAME:___________________________________

COMPANY NAME:_______________________________ DAYTIME PHONE NUMBER: (      ) _________________

STREET NUMBER:_______________STREET NAME:______________________________ APT/SUITE #:_______

CITY: ______________________________STATE: _______________________ ZIP CODE: _________________

ORDER INFORMATION
COMPLETE THIS SECTION FOR ALL ITEMS
DESCRIPTION
ITEM NUMBER
QTY
LOGO NO.
PRICE
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PHONE ORDERS/QUESTIONS 1-800-448-5944 ORDER SUBTOTAL ____________
FAX ORDERS: 1-510-336-3208 SALES TAX ____________
SHIPPING ____________
ORDER TOTAL ____________
PAYMENT INFORMATION
CHECK OR MONEY ORDER ENCLOSED (PAYABLE TO C.L.P. SPECIALTY ADVERTISING)
CHARGE TO THE FOLLOWING CREDIT CARD _____ VISA _____ MC _____ DISCOVER _____ AMEX
CARD NUMBER: _____________________________________________ EXP. DATE _______________

CARD HOLDER'S SIGNATURE: _____________________________________________________

NAME ON CREDIT CARD __________________________________________________________

MAILING ADDRESS: 2025A McArthur Blvd. Oakland, CA 94602-2214