                                                                               
                         FAST SERVICE ORDER FORM                               
                           NEBS ONE-WRITE PLUS                                 
                           and Compatible Forms                                
                                                                               
                                                                               
       Phone Number: (   )__________                                           
                                                                               
       Type of business:  _________________                                    
                                                                               
       MAILCODE 60954                                                          
                                                                               
       Authorized Signature:  _______________________  Date: ___/___/___       
                                                                               
       =================================================================       
                                                                               
       SECTION 1:BILL TO:  (DO NOT USE FOR PRODUCT IMPRINT INFORMATION)        
                                                                               
              Firm Name:  ______________________________________               
                                                                               
              Attention:  ______________________________________               
                                                                               
              Street Address:  _________________________________               
                                                                               
              City, State, Zip:  _______________________________               
                                                                               
       =================================================================       
                                                                               
       SECTION 2:SHIP TO:(FILL IN ONLY IF DIFFERENT FROM BILLING               
                          ADDRESS)                                             
                         (ENTER STREET ADDRESS NOT P.O. BOX)                   
                                                                               
       Firm Name:  _____________________________________________               
                                                                               
       Attention:  _____________________________________________               
                                                                               
       Street Address:  ________________________________________               
                                                                               
       City, State, Zip:  ______________________________________               
                                                                               
       =================================================================       
                                                                               
       SECTION 3:COMPATIBLE FORMS; CHECKS AND SUPPLIES                         
                 (PLEASE REFER TO CATALOG FOR PRODUCT OPTIONS AND              
                  ORDERING INFORMATION OR CALL 1-800-882-5254)                 
                                                                               
       QTY  PROD   DESCRIPT   CONSECUTIVE  TYPE   BUSINESS  UNIT  AMOUNT       
           NUMBER              NUMBERING   STYLE   DESIGN   PRICE $            
       _________________________________________________________________       
                                                                               
       _________________________________________________________________       
                                                                               
       _________________________________________________________________       
                                                                               
                                                                               
       ================================================================        
                                                                               
       SECTION 4:IMPRINT INFORMATION                                           
                 (SEND IN PRINTED SAMPLE OR FILL IN  BELOW)                    
                 (PHONE NUMBERS WILL NOT BE PRINTED ON ENVELOPES,              
                  MAILING LABELS OR POSTCARDS UNLESS INSTRUCTED)               
                                                                               
       PRODUCT NUMBER(S):  _____________  PRODUCT NUMBER(S):____________       
                                                                               
       _________________________________  ______________________________       
                                                                               
       _________________________________  ______________________________       
                                                                               
       _________________________________  ______________________________       
                                                                               
       __ YES IMPRINT MY ORDER            __ YES IMPRINT MY ORDER              
           WITH THE PHONE #                  WITH THE  PHONE #                 
       (_____)_____________________        (_____)______________________       
                                                                               
       __ YES IMPRINT MY ORDER            __ YES IMPRINT MY ORDER              
          WITH THE FAX #                      WITH THE FAX #                   
                                                                               
       (_____)_____________________        (_____)______________________       
                                                                               
       ===============================================+=================       
                                                                               
       SECTION 5:  CHECK ORDERING INFORMATION                                  
       CHECKS AND DEPOSIT TICKETS BY FAX OR MAIL: SEND YOUR COMPLETED          
       ORDER FORM WITH A "VOIDED" CHECK FOR ORDERING CHECKS.                   
                                                                               
       TO ORDER DEPOSIT TICKETS, SEND IN A "VOIDED" DEPOSIT TICKET             
.      BY FAX:   1-800-234-4324                                                
       BY MAIL:  NEBS INC.   500 MAIN ST.  GROTON, MA 01471                    
       BY PHONE: CALL FOR DETAILS, 1-800-882-5254                              
                                                                               
       =================================================================       
                                                                               
       SECTION 6:  TOTALS                                                      
                   TOTAL AMOUNT ORDERED         _________________              
                                                                               
               ___ YOUR COMPANY LOGO            _________________              
               (FIRST TIME CHARGE:  $25.00                                     
                REPEAT USE $5.00 PER PRODUCT)                                  
                                                                               
               ___ EXTRA WORDING                _________________              
               (TERMS, ETC., ADDITIONAL $6.00                                  
                CHARGE PER PRODUCT)                                            
                                                                               
                                      SUBTOTAL   ________________              
                                                                               
                       AZ,GA,MA,MO,TX,WI  TAX    ________________              
                       (Please pay applicable                                  
                        sales tax.)                                            
                                                                               
                       THANK YOU         TOTAL   ________________              
                                                                               
       ===============================================================         
