PERSONAL CHECK ORDER FORM - SuperValue Checks - …

1 PERSONAL CHECK ORDER FORMP lease print and complete the ORDER form below. 1 Start Here. Follow each step to properly complete ORDER form . Ad Code: 0103 2 Choose your style and quantity. Singles 125 Checks per pack. Duplicates 100 Checks per pack. 3 Options 4 Shipping & Handling. Choose form these shipping options. 5 Payment. Enter above amounts :Email: Daytime Phone: ( )CUSTOM LETTERING: #31 Standard (Free) #35 Retro #36 REGAL ADDITIONAL CHECK REGISTERS: ADDITIINAL DEPOSIT SLIPS:$ ( CHECK one typestyle) #38 Elegant #41 JAZZ #42 CASUAL 2 Qty $ + $ S/H 100 Qty $ + $ S/H 200 Qty $ + $ S/HInquiries 1-866-747-2196 100% SATISFACTION GUARANTEED Mon-Fri 7am-9pm CT, Sat 8:30am-12.

2 30pm, 1:00pm-5:00pm CT, Closed Sundays AMERICAN EXPRESS DISCOVER VISA MASTERCARD$ AMOUNTP ayment Type: CHECK Enclosed Debit Account Credit Card (payable to SuperValue Checks ) (enclosed voided CHECK ) (fill in payment below)Credit Card Number Security Code Cardholder Signature EXP. DATE (MO/ YR) please ENCLOSE: VOIDED CHECK or reorder form ( please indicate changes) - DEPOSIT SLIP from the same account Mail ORDER form WITH PAYMENT To: SuperValue CHECKSPO Box 350080, New Braunfels, TX 78135or Fax orders to: 1-866-747-2196 Super Value Checks CHECK ORDER FormSuperValue Checks Pricing.

3 $ _____ FraudArmor (Recommended) $ per pack ..$ _____Optional Custom Message $ ..$ _____Additional CHECK Registers ..$ _____Additional Deposit Slips ..$ _____Shipping & Handling ..$ _____In Plant Rush (Save 2 days production) $ ..$ _____Add Sales Tax (All states) ..$ _____TOTAL ..$ _____Checks shipped to address printed on your Checks . Regular Delivery (12-14 business days) 1 pack $ 2 packs $ 3 packs $ 4 packs $ SmartTrack - RECOMMENDED ( 8-12 business days) Continental US Orders 1 pack $ 2 packs $ 3 packs $ 4 packs $ UPS Ground (6-10 Business Days) 1 pack $ 2 packs $ 3 packs $ 4 packs $ 2-Day Delivery (5-7 business days) 1 pack $ 2 packs $ 3 packs $ 4 packs $ Overnight Delivery (4-6 business days after receipt of ORDER ) Continental US Orders 1 pack $ 2 packs $ 3 packs $ 4 packs $ SAVER Checks Classic Favorites _____ Flowers & Garden _____ Animals & Wildlife _____ Hobbies & Interest _____ Landscapes & Scenery _____ Patterns & Designs _____ Faith & Inspiration _____ Yellow Safety _____ Blue Safety _____ Scroll _____ Monarch _____ New Designs _____ Disney _____ Classic & Pop Icons _____ Star Wars _____ Comic & Super Heroes _____ At the Movies _____ Fashion & Lifestyle _____ Fun & Charm _____ Inspirational _____ Patriotic _____ Floral _____ Checks for a Cause _____ Artistic Patterns _____ Hobbies & Interests _____ Dena Designs _____ High Security _____ Side-Tear _____ Eco-Friendly _____ Custom Checks _____EVERY DAY VALUE Checks (Select category and enter design name)

4 PREMIER DISCOUNT Checks (Select category and enter design name)Singles 1 pack $ 2 packs $ 3 packs $ 4 packs $ 1 pack $ 2 packs $ 3 packs $ 4 packs $ 1 pack $ 2 packs $ 3 packs $ 4 packs $ 1 pack $ 2 packs $ 3 packs $ 4 packs $ 1 pack $ 2 packs $ 3 packs $ 4 packs $ 1 pack $ 2 packs $ 3 packs $ 4 packs $