Signcerely: Orders: Simi Medical Building

Please fill out and print this form, then fax it to (805) 581-1947. Also, mail a copy of this form with your check... or put your Credit Card information at the bottom of this form. We accept M.C. VISA & Discover credit cards or check cards.

	Qty (each)	Please type your Co. name(s) & Suite # as you would like them to read for each sign.
#A: Door Sign		Name
#B: Frame for above.
#C: Window Lettering		Name	Logo: Please E-mail or Snail mail
#D: Directory Strip		Name	Suite #

Ordered & Approved By:
Contact Name:
Contact e-mail:
Contact Ph#:
Contact Fax#:
Ship To:
Name:
Address:
City, State:
Zip:

Sub Total:
Tax: (8.25%)
Shipping:
Total:

Please Remit Check or Money Order of Total Amount Due to;
Signcerely
628 Bluegrass St.
Simi Valley, CA 93065-6232
Ph# 805-527-6838
Fax# 805-581-1947
e-mail: signcerely@sbcglobal.net

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#A: Door Sign	3"h x 15"w	Dark Brown w/ White Letters	$65.50ea.
#B: Frame for above	3.25"h x 15.4"w	Flat Black	$85.00ea. (installed)
#C: Window Lettering	24'w x 24'h(approx)	White	$175.00(installed)
#D Directory Strip	.5"h x 7"w		$35.00