Please fill out form. Hitting send button delivers it to Eye-Dye. Thankyou.

CUSTOMER SHIP TO:

Customer ID#:

Company Name:

Contact Name:

Address:

Address 2:

Suite:

City:

State: Non U.S. State

Zip:

Tel:

Tel 2:

Fax:

Cell:

Email:

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CUSTOMER BILL TO:

Same as Ship To:

Customer ID#:

Company Name:

Contact Name:

Address:

Address 2:

Suite:

City:

State: Non U.S. State

Zip:

Tel:

Tel 2:

Fax:

Cell:

Email:

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ADDED DROP SHIP ADDRESS:

Customer ID#:

Company Name:

Contact Name:

Address:

Address 2:

Suite:

City:

State: Non U.S. State

Zip:

Tel:

Tel 2:

Fax:

Cell:

Email:

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PAYMENT INFORMATION:

CREDIT CARD INFO:

Card Number: Expire Date: Security Code:

Amex 4 Digit Security Code:

Name On Card: Company On Card:

Card Bill To Address: City: State: Zip:

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ORDER DATA:

Po Number:

Due Date: Cancell Date: Dated Event: In Hand Date:

SHIPPING INFO: PC users hit control to select more then one option.

                              MAC users hit command to select more then one option.

ARTWORK : PC users hit control to select more then one option.

                      MAC users hit command to select more then one option.

Use Previous Artwork:

LOCATION OF PRINT: PC users hit control to select more then one option.

                              MAC users hit command to select more then one option.

OTHER CHARGES:

Artwork --------------- $30.00 / HR

Film ------------------- $10.00 / FT

Screen ---------------- $20.00 / EA

Sample Print ---------- $25.00 / Color

Color Change --------- $10.00 / EA

Sample Tie-Dye ------- $25.00 / EA