BILL TO: (Complete ONLY if different from shipping information)

* * * *  Orders are  accepted for customers in the               Continential United States ONLY

* * * * * This Order Form is for Products from the                   Kaeser & Blair Catalog ONLY

BILLING INFORMATION

NOTE:     CardHolder can provide information below or call  information  in to agent. (323  * 752-8887)

I hereby approve the terms of this contract, please charge the balance due to my charge card, to prepay my custom order.

ORDER

       Note:  Extra Charges, Tax and Transportation charges will be computed and you will be informed before   order is  commenced.

(P.O. must be made payable   to Kaeser & Blair, Inc.)

PEN ORDERS:

WEARABLES:

SHIPPING:

ARTWORK:  E-mail to: artdept@kaeser-blair.com.  Date: ___/___/___.   IMPORTANT:   Include copy of art with order, as  attachment 

I. & W. SPECIALTY

ORDER FORM

K&B Open Account

Open Credit Acct. (See Credit Application)

Prepayment by Credit Card.

Choose OneMasterCardVisaDiscoverAmerican Express

This is exact repeat of previous K&B order#_________

Refer to last K&B order#________    with noted changes.

Choose OneFine PointMed. Point

Rated In D&B

Ground/5 + Days2 Day/Blue3 Day/Orange1 Day/Red

Copy (Imprint) Wanted:

Trim Color: Barrel Color:  Refill Color:

S :        M: L: X-L: XX-L: XXX-L: XXXX-L:

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