| RAPID RESPONSE FEEDBACK FORM |
| FROM: |
| DATE: |
| PHONE: |
| FAX: |
 |
 |
| ATTN: GOVERNMENT BUYER We are a woman-owned small business We will cross-reference Black Box, CDW, Global, and 80 other catalogs over to our lower prices! |
| PLEASE CHECK ONE: |
| QUOTE ORDER |
| REQUEST |
| "Proudly serving the Federal Goverment nationwide since 1983." |
| FAX 973-989-8830 email at: [email protected] |
| PHONE 888-DATAPAGES OR 973-989-0400 |
| We take all Government Impac credit cards: Visa, M/C, Amex |
| Ship To: |
| Agency: |
| City,State,Zip: |
| Special Shipping: |
| Bill To:(If different than Ship-To) |
| QUANTITY |
| COMPETITOR ITEM # IF APPLICABLE |
| PAGE NO. |
| COMPLETE PRODUCT DESCRIPTION |
| UNIT PRICE |
| EXT. |
| How I want to Pay: (Choose One) |
| A) Purchase Order |
| PO# |
| B.)Credit Card Type: |
| VISA |
| M/C |
| AMEX |
| Card Number w/ Exp.date: |
| Card Number w/ Exp.date: |
| Card Number w/ Exp.date: |
| Shipping FREE unless requesting overnite delivery |
| .$00 |
| GRAND TOTAL |
| Name on Card: |
| REMIT TO ADDRESS: DATA-PAGES, INC. PO BOX 663 CHESTER, NJ 07930 |
| 85 Franklin Rd., Dover, NJ 07801 |
| E-MAIL: |
 |
