Old Republic Title Calendar Order Form

* Indicates a required field

Company Name: *

Contact Name: *

Phone Number: *

Fax: *

Email Address: *

Do you have Multiple Shipping Addresses? *

Yes
No

(If you select "Yes," please enter your primary Shipping Address below and we will contact you and get the additional shipping addresses.)

Shipping Address: *

Shipping City: *

Shipping State: *

Shipping Zip Code: *

Billing Address: *

Billing City: *

Billing State: *

Billing Zip Code: *

One billing address allowed per order. If you have multiple billing addresses please fill out a separate order for each billing address.

Price: $2.69 each

Based on a 14-month calendar.
Example: November 2011 - December 2012 is a 14 month calendar.

Quantity of Calendars:

Indicate your quantity below. Orders must be in multiples of 25 due to carton size. If the quantity you have indicated is not evenly divisible by 25 we will round up your quantity to the next even amount.

Minimum quantity: 200 calendars.
May order 100, 125, 150, or 175 for an additional $75.00 flat.

Quantity: *

Order Type: *

Starting Month for Calendar: *

Ending Month for Calendar: *

Please Choose Your Sales Representative: *

Delivery:
Orders must be submitted and finalized by August 1, 2011 for October delivery.
Order is not considered final until submission is received and proof (if sent) of your order is approved.
Questions? Please call.

Special Instructions:

Upon receipt of your order, a Dataguide representative will contact you with instructions on how to submit copy to customize your calendar. Proofs will be sent for your approval, once copy is received.

If you have any questions, please call:
Customer Svc: 800-343-0583 / Email: sales@dataguide.com

Old Republic Title Deskpad Calendar Online Order Form