MIME-Version: 1.0 Content-Type: text/html; charset="utf-8" Content-Transfer-Encoding: quoted-printable X-MimeOLE: Produced By Microsoft MimeOLE V6.00.2900.3138 =EF=BB=BF
Payment = Sheet
Account Number: If you know = it
=C2=A0
Date:=20
Billing
School Name:
Contact Name: Contact = Email:
Contact Phone: Contact = Fax: Contact = Cellular:
District Name:
Billing Address Line 1:
Billing Address Line 2: Billing = Address Line 3: City: =
=C2=A0
State: Zip: =

Shipping
=C2=A8Same As = Billing
School Name: Contact Name: Contact Email: Contact Phone: Contact Fax: Contact Cellular:
=C2=A0
District Name: Shipping Address Line 1: Shipping Address Line 2: Shipping Address Line 3: City: State: Zip:
=C2=A0

=C2=A0
=C2=A0

Method of Payment = *If Purchase Order is selected = please fax a copy of it

=C2=A8= Purchase Order
=C2=A8= Check
=C2=A0
=C2=A8= Credit Card
=C2=A8= Procurement = Card
=

Credit = Card

Select One:
=C2=A0
=C2=A8= Visa=C2=A0=C2=A0=C2=A0 =C2=A8= MasterCard
=C2=A8= American Express
Card Number:
Expiration Date: =
CCID:
Name On Card:
=C2=A0=C2=A0

=C2=A0
=C2=A0
=C2=A0

Signatures

For Credit Card Purchases please have = the card holder sign.
=C2=A0
Approval = Signature
=C2=A0
Date