/ FAME Publication
order form / Date Form submitted: Time submitted:
Date Job due: Time due:
Completion instructions
1.  Save this form to your hard disk before completing it.
2.  Tab to each field to enter order information inline.
3.  To maintain the integrity of the form, rename the form when you save it.
4.  Submit your completed order to Dollar Bill. / Please provide any customer-satisfaction feedback to SunGard at .

Customer Information

Company name /
Contact name
Address / Day: Day Phone / Ext:
Address Line 2 / Evening: Evening Phone
City / State/Province / Fax: Fax number
Zip/Postal Code / Country / e-mail: e-mail

Document Order Information(In addition to the cost of publications, Dollar Bill will add a $5.00 handling fee per box or package shipped.)

Publication
/
ID Code
/
Unit Price
/
Quantity
/
Total Price
Enter complete name of guide as it appears on list / Enter ID Code

Special Order Instructions

No special instructions
Payment Method for publications order
SunGard customer orders only: / Internal SunGard orders only:

Indicate credit type

/

Enter Account Number

/ /
Customer charge at Dollar Bill
Department: / Enter account number
PO # / FAME charge at Dollar Bill
Department: / PO #
Customer Credit Card
Type: VisaMasterCardDiscoverAmerican ExpressDiners Club / Enter card number
Expiration Date: 01/00

Shipping (Dollar Bill will ship within 48 hours of receipt of order)

/ / Deliver to (if different from Customer Information address)
Bill shipping to: /
Enter Account Number:
/ / Must be physical address, not P.O. Box
FedEx account number:
UPS account number
Credit Card number
Type: VisaMasterCardDiscoverAmerican ExpressDiners Club / Expiration Date: 00/00
Shipping priority: / Priority OvernightStandard OvernightFirst Overnight2Day (second business day)Express Saver (3rd business day)

Submit Your Order to:

Dollar Bill Copying

/
Fax this form to: 734.930.2800 or e-mail as an attachment to . / 9/06
Telephone: 734.665.9200