Company Name or Company Code *

Contact Name *

Shipping Address * (WolfePak/UPS cannot ship to P.O. Boxes)

Phone Number * (Please include an extension if applicable)

Email Address * (This address will be used to confirm your order and to receive your invoice)

Scanner Order # 1 *

Kodak i1150 ($429 plus tax and shipping) Kodak i1190 ($698 plus tax and shipping) Kodak i2420 ($797 plus tax and shipping) Kodak i2620 ($1050 plus tax and shipping) Kodak i2820 ($1489 plus tax and shipping)

How many scanners? * (Type in how many for order #1)

Scanner Order 2

Kodak i1150 ($429 plus tax and shipping) Kodak i1190 ($698 plus tax and shipping) Kodak i2420 ($797 plus tax and shipping) Kodak i2620 ($1050 plus tax and shipping) Kodak i2820 ($1489 plus tax and shipping)

How many scanners? (Type in how many for order #2)

Scanner Order 3

Kodak i1150 ($429 plus tax and shipping) Kodak i1190 ($698 plus tax and shipping) Kodak i2420 ($797 plus tax and shipping) Kodak i2620 ($1050 plus tax and shipping) Kodak i2820 ($1489 plus tax and shipping)

How many scanners? (Type in how many for order #3)

Kodak Scanner Maintenance Kit (Contains Extra Rollers, Cleaning Pads, Scanner Wipes)

None Maintenance Kit ($60 plus tax and shipping)

Number of Kits

Special Instructions (You can add a special PO#/Special Delivery Instructions/Etc.)

Human Test