Laser Checks Order Form

info@micrprint.com
Toll-Free Number: 1-800-784-2800

Shriners Laser Checks
Order Form

Your Name:

Daytime Phone:

Imprint Name:

Max imprint 5 lines w/ 40 characters and spaces per line:

Shipping Address:

If different from imprint

Software:

* Please send us a sample copy of
the check format you are ordering.

Version:

Logo Imprint:

Special Typestyle:

Check Color:

Check:

* Color selection and
prices must match
configuration choice

Check-Check-Check:

Signature Lines:

Start my checks at #:

(#1001 if not indicated)

Configuration:

Prices:

1 Check Per Page
Quantities	Price
250	$99.75 per lot
500	$127.05 per lot
1,000	$173.25 per lot
1,500	$244.65 per lot
2,000	$306.60 per lot
2,500	$358.05 per lot
3,000	$405.30 per lot
4,000	$496.65 per lot
5,000	$523.95 per lot
10,000	$987.00 per lot

Check-Check-Check
Quantities	Price
900	$99.00
1,200	$131.00
1,500	$153.00
1,800	$166.95
2,100	$187.95
2,400	$208.95
2,700	$232.95
3,000	$250.95
For orders over 3000 please call for a quote.

(Quantity) @

(Price per Set)

Special Typestyle:

$2.00 (optional)

Custom Logo:

$25.00 (optional and only on first order)

Endorsement Stamp:

$13.95 (optional)

Deposit Tickets:

(Available in Single Only) imprinted.

Double Window Envelopes:

Two day rush service*:

($45.00 additional)

*Standard Production time is four days plus
delivery. Includes UPS blue label upcharges.

Subtotal:

Shipping Charges: (REQUIRED)

(use shipping chart below)

Subtotal:

Sales Tax:

MD 6%, WA 9%

Grand Total:

Shipping Prices Chart:

Order Price

Shipping

$0 - $50
$51 - $100
$101 - $150
$151 - $200
$201 - $300
$301 - $400
$401 - $600
Over $600

$22.00
$27.50
$33.00
$38.50
$49.50
$55.00
$66.00
$99.00

*(Alaska, Hawaii, Puerto Rico, and US Virgin Islands, please call for shipping rates at: Toll-Free Number: 1-800-784-2800)

How to order:

Enclose a voided check or reorder form from your existing check supply marking any changes as needed.
Enclose a deposit slip from your existing checking account.
Complete, print, and enclose this order form with your check in payment to:

(allow 2-3 weeks for delivery)

page udated 6/1/10 by Zephyr Sites

Shriners Laser Checks Order Form

Shriners Laser Checks
Order Form