Patient Demographic Form
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1TODAY’S DATE:
EXPRESS SCREEN PRINTING
326 South Siesta Lane, Suite 3
P.O. #:
Tempe, Arizona 85281
IN-HANDS DATE:
tel: 480.967.7022 | fax: 480.967.2192
In-hands date is:
Firm
Flexible
WORK ORDER
Work order is:
First
Revised
CLIENT CONTACT INFORMATION
Notes (office use only):
0
Art
Film
Total
Name:
Phone:
Fax:
Email:
JOB COMPLETION AND SHIPPING INSTRUCTIONS
JOB
Call when job is complete
Reorder
Job P.O.#:
Ship to:
/
/
New
Date sent:
Attention:
Street address:
ARTWORK
Email proof requested
Sent by email:
City:
State:
Zip code:
Sent by other:
PRODUCTS
Will call
Courier
Ship via:
Arrival date:
Packing / shipping notes:
/
/
/
/
APPAREL COLOR | APPAREL SIZES
XS
SM
MD
LG
XL
2XL
3XL
TOTAL
0
0
0
0
0
0
0
GRAND TOTAL:
0
LOCATION OF ARTWORK – FRONT
INK COLORS – FRONT
Special instructions:
Check the boxes that apply.
1.
2.
3.
POCKET
4.
SHIRT FRONT
please select location
5.
6.
RIGHT SLEEVE
RIGHT
LEFT
LEFT SLEEVE
LOCATION OF ARTWORK – BACK
INK COLORS – BACK
Special instructions:
Check the boxes that apply.
1.
2.
3.
4.
SHIRT BACK
RIGHT
LEFT
5.
please select location
6.
LEFT
RIGHT
PANTS / SHORTS FRONT OR BACK
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Parent category: Business