DenLine Uniforms, Inc. - Quotation Request Form

Print out this form, complete, and fax to: 217-228-8825 - International Fax: (001) 217-228-8825

Date: Mo____________ Day ____ Year_____ Page No._________
Your Name:_________________________________________________
Institution or Practice Name:______________________________ Department:___________________________
Address:_________________________ Suite No.______________
City:________________________ State:_____ Zip:___________ Country: ____________
Phone: Country Code:_________ Number:_(_____)_____________
FAX: Country Code: _________ Number:_(_____)_____________
Your E-Mail Address:______________________________________ 		Quote No._______
Date ___________

These Two Columns to be Completed by DenLine
Item No.
Color
Size
Description
Quantity to Quote
Price Each
Total
1._____ _______ _______ ______________ __________ _______ _______
2._____ _______ _______ ______________ __________ _______ _______
3._____ _______ _______ ______________ __________ _______ _______
4._____ _______ _______ ______________ __________ _______ _______
5._____ _______ _______ ______________ __________ _______ _______
6._____ _______ _______ ______________ __________ _______ _______
7._____ _______ _______ ______________ __________ _______ _______
8._____ _______ _______ ______________ __________ _______ _______
9._____ _______ _______ ______________ __________ _______ _______
10._____ _______ _______ ______________ __________ _______ _______
For More Than 10 Items, Use Additional Copies of This Form.
 Sales Tax - (7.75% Illinois Only) _______
Embroidery Price: One Line @ $6.00
Two Lines @ $8.95		 No._______ Embroidery Cost _______
Silk Screen Price: $25 Set up plus cost per garment No._______ Silk Screen Cost _______
Quote Good For 30 Days From Date Issued. Due To Style Changes, Merchandise Quoted Is Subject To Availability At Time Of Order.

To Order Merchandise By Fax, Complete Form and Fax to DenLine at the Number Shown Above.

 COD - Continental US Only ($8.00) _______
Shipping & Handling _______
QUOTE TOTAL _______
Check or Money Order Enclosed Mastercard VISA Discover COD (Continental US Only)

Card Number: Good Thru:___/___

Signature:_______________________________________________________________ Date:_______________________________________