Valutec Card Solutions: A Metavante Company
Choice Order Form
Personal Information :
 Contact Name :
 
 DBA Name:
 
 Company:
 
 Mailing Address :
 
 City:
State:
 Zip Code :
 
 Phone Number :
 
 Fax Number :
 Email Address :
 
 Number of Store Locations :
 
What type of credit card terminal are you using (if known) :
 
Card Program Order Information:
Choice Card Program
 
Gift Card
 
Loyalty Card
Enter Your Merchant Name as you would like it to appear on the card:
Custom Card Options :
How will you be supplying your artwork?
* There is a $25 charge to use an image from the Photo Library. To see choices, click here: www.photos.com
Photos.com Stock Photo # (if applicable)
Card Back Verbiage:
 
Standard (card back verbiage)
 
Custom (provide text along with artwork)
Ship Card order to: Address above Address below
 Company:
 
 Mailing Address :
 
 City:
State:
 Zip Code :
 
 Shipping Phone Number :
 
 Fax Number :
How did you hear about Valutec?        If other...Type below
Additional Comments:
VALUTEC | PH: 615.771.8700 | FAX: 615.771.3500 | 113 Seaboard Lane, Suite A-200 Franklin, TN 37067 | Copyright 2006, Valutec Card Solutions

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