Company:
Contact Name:
Address 1:
Address 2:
City:	State:   AB AK AL AR AZ BC CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MB MD ME MI MN MO MS MT NB NC ND NE NF NH NJ NM NS NT NV NY OH OK ON OR PA QC RI SC SD SK TN TX UT VA VT WA WI WV WY YT Other   ZIP:
Phone:	( ) – Ext.
E-Mail:
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Quanity:
Recording Length:
Shell Color:	Choose Color White Clear
Imprint Color:	Choose Color None White(For Clear Shell Only) Black (Not For Clear) Color
Packaging:	Choose Packaging Type Bulk (no packaging) Norelco Box Soft Poly Other
Label:	Choose Type of Label None Full Color Label B/W Label
J-Card:	J-Card None Yes No
Extra Panels:	J-Card Panel None 1 2 3 4 5 6 7 8 9 10 11 12
Colors Outside:	Blank Black/White Full Color
Colors Inside:	Blank Black/White Full Color
Shrink Wrap:	Yes No