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Online Order - Brass

I want to order from	*REQUIRED FIELD
Dies needed by:
Company name:
Customer Number:
Customer contact:
Street address:
City:
State:
Country:	Postal Code/ZIP:
Telephone:
Fax:
E-mail:	* VALID E-MAIL ADDRESS REQUIRED
Purchase Order Number:

Specify type of engraving below:
Brass Combo Die :	Quantity: Heat Comp.

Brass Emboss Die:	Quantity: Press Proof ($40 per die.)

Brass Deboss Die:	Quantity: Latex Proof

Brass Flat Stamp Die:	Quantity: Other:

Magic Dupes (for emboss dies):	Quantity:

Combo Pre-cast Counters:	.015 .030 .047 .060 .125

Emboss Pre-cast Counters:	.015 .030 .047 .060 .125

Registers to Litho:	Yes No

Type of Stock (Substrate):	Sample sent

Include score on emboss die?	Yes No Emboss Deboss Step down

Stamp Design Number on die?	Yes No Design number:

Heidelberg Lip?	Yes No

Special Notching / Window Cut-outs?	Yes No (Please send drawing to indicate locations.)

Mount Type High? ($30 minimum)	Yes No

Shipping method:	Priority AM Economy
Special shipping:	First AM, if available Saturday Hold for pick up at station address below:
Special instructions: