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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


We generate fears while we sit. We over come them by action. Fear is natures way of warning us to get busy. | Dr. Henry Link