Instructions
• Print this form
• Fill out this form completely. Incomplete forms will be returned.
• If mailing, include your credit card information or make your check or money order payable to "CD LabelCorp" and mail to:
CD LabelCorp
PO Box 219011
Beaverton, OR 97225-9011 USA
Please do not send cash. All checks and money orders must be preprinted and in US dollars. There will be a $25 service fee on returned checks.
• If faxing, include your credit card or purchase order information and fax to:
(800) 600-0312 or (310) 842-7795
We only accept Credit Card FAX orders
• Purchase Orders are accepted from US companies, State & Local Agencies and Municipalities (pending credit approval). First time orders may require a credit card or prepayment. Purchase orders are only accepted by fax, with the order form and signed Purchase Order. Fax to (310)842-7795

CUSTOMCD LABELS & APPLICATOR TOOL LABEL COLOR PRICE QTY
1000 CustomCD Labels w/ Applicator Tool White or Gold $139.95 ______
300 CustomCD Labels w/ Applicator Tool White or Gold $49.95 ______
100 CustomCD Labels w/ Applicator Tool White or Gold $19.95 ______
10 CustomCD Labels White or Gold Free + S/H ______
Label Applicator Tool
$7.95 ______

CD-R MEDIA ON SPINDLE EACH LABEL COLOR PRICE QTY
1000ea CD-R $.40 ea White or Gold $400 ______
500ea CD-R $.40 ea White or Gold $200 ______
100ea CD-R $.45 ea White or Gold $44.50 ______
50ea CD-R $.45 ea White or Gold $22.50 ______


Sub Total
____________
Tax is for California residents only (8.25%)

Shipping Charges:
Email support@cdlabelcorp.com for shipping charges.
Tax
____________
Shipping
____________
Total
____________

All fields in the billing section are required
Bill To: Payment Method:
Name: ____________________________________
Address: ____________________________________
City: ____________________________________
State: ____________________________________
Zip: ____________________________________
Phone: ____________________________________
Phone:
(evening) 		 ____________________________________
Email: ____________________________________
Check
Money Order

Mastercard
Visa
Discover Card
American Express

Card Number:   
________________________

Expiration Date:
____________ (i.e. 01/02)

Fill out the Shipping Information only if different from your billing information.
Shipping Information
Name: ____________________________________
Address: ____________________________________
City: ____________________________________
State: ____________________________________
Zip: ____________________________________
Phone: ____________________________________
Phone:
(evening) 		 ____________________________________
Email: ____________________________________
 Thank you for your order.