Check Designer
                            Check Order Form
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     [  ]  100 Triple Check Sheets (300 checks) ......... $ 10.00
     [  ] 1000 Triple Check Sheets (3000 checks) ........   90.00
     [  ] 3000 Triple Check Sheets (9000 checks) ........  200.00

     [  ]  100 Voucher Check Sheets (100 checks) ........   10.00
     [  ] 1000 Voucher Check Sheets (1000 checks) .......   90.00
     [  ] 3000 Voucher Check Sheets (3000 checks) .......  200.00 
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    *[  ] MICR Printing for 100 Triple Check Sheets .....    2.00
    *[  ] MICR Printing for 1000 Triple Check Sheets ....   18.00
    *[  ] MICR Printing for 3000 Triple Check Sheets ....   40.00

    *[  ] MICR Printing for 100 Voucher Check Sheets ....    1.00
    *[  ] MICR Printing for 1000 Voucher Check Sheets ...    9.00
    *[  ] MICR Printing for 3000 Voucher Check Sheets ...   20.00
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     [  ] SECOND DAY AIR SHIPPING .......................   15.00
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                                              TOTAL    ________
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     Shipping is done U.S. Mail parcel post (unless otherwise
     specified) and arrive anywhere in the U.S. within about
     three days to two weeks.

    *IMPORTANT NOTE: If you choose the MICR Printing option, you
     must enclose a blank voided check (just write VOID across
     the check).  I'll print the same MICR information that is
     on the voided check.  Due to the possibility of fraud, I
     will NOT print any MICR information other than what is
     shown on a blank voided check.

     Mail this form and a check or money order for the total to:

		Matt E. Hart
		2516 W. Kingsport
		Broken Arrow, OK  74011
		CIS: 75450,3705
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