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Ordering

Order Form

You may print this form and fax it to 734.665.7850 or submit it electronically. Either way, your order will receive immediate attention and confirmation by email (for online orders) or telephone (if order was faxed).

Departmental Information for the ordering department

Please note that all fields in red are required.

Departmental information for the ordering department
Department name:
Department contact name:
Contact phone (555-555-5555):
Contact email:
Complete billing address:

M-Stores short code(s):



Name of authorized signer:

Job descriptions of positions to be filled

Job 1
Qty.
Start Date: Start Time:

Job 2
Qty.
Start Date: Start Time:

Job 3
Qty.
Start Date: Start Time:



If you selected “other” for any job categories, or have a medical/healthcare request please describe:


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