|   | Company Name: |
| Company Address: | Phone: | |
| Street: | Cell#: | |
| City: | Fax: | |
| State: | Zip: | Email: |
| Website: | ||
| Bill To: Address | Ship Samples To: Address |
|   |   |
| Purchase Order #: |   |
| Date: |   |
| Business Owner: |   |
| Business Description: | |||
| Postcard Description: | |||
|   | |||
| New Work: | Reprint: | Client Supplied Art: | AMS Supplied Art: |
| Quantity | Size | 4/1 | 4/4 | 12 Point Stock | 14 Point Stock | UV 1 Side | UV 2 Sides | AMS Art | Deposit Amount | Balance Due |
|   |   |   |   |   |   |   |   |   |   |   |
|   |   |   |   |   |   |   |   |   |   |   |
|   |   |   |   |   |   |   |   |   |   |   |
|   |   |   |   |   |   |   |   |   |   |   |
|   |   |   |   |   | Check #: |   |   |   |   |   |
|   |   |   |   |   | Paid by: |   |   |   |   |   |
| This Purchase order should be sent with deposit: Attn: Zachary Sachs Publisher/Mgr. American Marketing Services, LLC PO Box 562 Wilton, CT 06897 Note: Upon receipt of purchase order&deposit, AMS will Forward a formal List contract to the authorized buyer. |
  |   | Subtotal |   | ||||||
|   |   | TAX |   | |||||||
|   |   | Ship |   | |||||||
|   |   | Extras |   | |||||||
|   |   | Bal. Due |   | |||||||
| This Purchase order is authorized by: |
| Sign Name Here: |
|   |
| Print Name Here: |