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ORDERED BY: SHIP TO (if different):
Name Name
Organization Name Organization Name
Street Address Street Address
P.O. Box P.O. Box
City, State, Zip City, State, Zip
Daytime Phone Daytime Phone
PAYMENT: choose one of the following payment options
Check / Money Order payment enclosed.
Make payable to Department of Administration
*State Government Customers Only
* Customer Use Code for billing purposes * Customer Optional Data (12 char. limit)
Visa (13 or 16 digits) CREDIT CARD ORDERS ONLY:
MasterCard (16 digits) call 1-800-DOC-SALE (362-7253)
*P-card (Visa) Local: 608-266-3358 $2.50 fee applies
Card number CVC number
Signature Exp. Date
for DOA ofce use only
Date Clerk #
Order # Customer #
Approval # New Exp. Date
Amount Paid
Payment Type
CA CH V/MC GSBS FR
TO ORDER:
• ChoosepublicationsfromtheSelectionside(onreverse)ofthisorderblank.
• CalculateyourSubtotal.TransfertheSubtotalamounttoLineAbelow.
• Complete“OrderedBy”,“ShipTo”,and“Payment”elds.
• Usingcheckormoneyorder?MakepayabletoDepartment of Administration.
• Onlycreditcardordersareacceptedbyphone.A$2.50feeappliestotheseorders.
• Forfurtherinformation,call608/266-3358.
SPECIAL NOTE:
TheDepartmentofAdministrationaddsafeeof$2.50onallcreditcardorders.
Thereisnoadditionalfeeforpaymentsbycheck,moneyorder,or
General Services Billing code. Only credit card orders are accepted by phone .
A. (fromSelectionpage)SUBTOTAL
B. Statetaxexemptcode(ifapplicable)
C. Wis.residents,add5%salestax
D. Add0.5%countysalestax(ifapplicable)
E. Add0.1%stadiumtax(ifapplicable)
F. Add$2.50creditcardfee(ifapplicable)
G. GRAND TOTAL
Publications Order Blank: Payment
No. 40, November 2014
SEND ORDERS TO:DocumentSalesUnit—DOA•4622UniversityAve.•Madison,WI53705-2156
AvailableWisconsinJobCenterpublicationsarelistedontheSelectionpageofthisform!
DOWNLOAD HERE


People don’t believe what you tell them. They rarely believe what you show them. They often believe what their friends tell them. They always believe what they tell themselves. | Seth Godin