KNIGHTS OF COLUMBUS
FORM NO. 1 (3/07)
SUPPLY DEPARTMENT
DATE
REFER TO CONTROL NO.
78 MEADOW STREET, NEW HAVEN CT 06519-1759 (203) 752-4214 or (203) 752-4451 FAX 1-800-266-6340 U.S. and Canada
NO.
REQUIRED INFORMATION – PRINT CLEARLY FOR MAILING LABEL NAME
TITLE
STREET OR P.O. BOX NO. (AVOID P.O. BOX UNLESS NECESSARY)
COUNCIL # ASSEMBLY #
GEN. AGENT #
CIRCLE #
FLD. AGENT #
PLEASE PRINT CHARGE TO (REQUIRED)
CITY
STATE/PROVINCE
DAYTIME TEL. # ( FAX # (
ZIP/POSTAL CODE
PRINT ABOVE NAME & NO. OF COUNCIL ASSEMBLY AGENCY OR CIRCLE
)___________________________________
)_____________________________________________
CITY
STATE/PROVINCE
STATE CODE
ZIP/POSTAL CODE
SIGNATURE REQUIRED (FS, GK, FN, FC, CC, CS, NOTARY, GA or FA)
TITLE (REQUIRED)
ALL PRINT JOB ORDERS MUST BE ON A SEPARATE FORM 1 WITH SAMPLE ATTACHED QUANTITY
ITEM/ FORM NUMBER
SHIPPED
UNIT PRICE
DESCRIPTION
I F N E C E S S A RY
Subtotal
Need by Date: Picked By
Packed By
Date Shipped
PAYABLE IN U.S. FUNDS — Make check or money order payable to: Knights of Columbus Supreme Council, 78 Meadow St, New Haven CT 06519-1759
CT Residents add 6% sales Tax CANADIAN residents add 6% GST NB, NF, NS& LAB residents add 14% HST
Check/Money Order No. ___________ Amount __________ OR charge it to your Mastercard M or VISA M IF CHARGING TO COUNCIL, AGENT, ETC. DO NOT FILL OUT CREDIT CARD BOX
MMMMMMMMMMMMMMMM Expiration Date: Month __________________ Year ___________ ___________________________________________________ SIGNATURE REQUIRED for credit card orders
1
TOTAL
OFFICE USE ONLY
Shipping and Handling TOTAL AMOUNT
EXPLANATION CODE CI — CANNOT IDENTIFY/UNKNOWN ITEM O — ITEM IS OBSOLETE R — PLEASE REORDER – ITEM IS NOW OUT OF STOCK BO — ITEM IS ON BACKORDER AND WILL BE SHIPPED ASAP S — SUBSTITUTE PROVIDED V — SPECIAL ORDER – VENDOR ITEM SHIPPED SEPARATELY
ORDER BILLING MEMORANDUM – BILLING COPY
FAX YOUR ORDER • 1-800-266-6340 (US AND CANADA) • DO NOT MAIL FAX ORDERS DO NOT REMOVE THIS TAB — KEEP LAST PAGE ONLY FOR YOUR RECORDS