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Notary Public Supply and FREE Membership Order Form

Please note: One student per form
DESCRIPTION UNIT PRICE QUANTITY AMOUNT

Notary Ideal Self Inking Desk Stamp $27.00 (Copy of license or stamp required) $ ___________.______

Notary Pocket Slim Stamp $39.70 (Copy of license or stamp required) $ ___________.______

Notary Logbook with Bound/Numbered Pages $27.00 $ ___________.______

Notary Seal/Embosser $47.70 (Copy of license or stamp required) $ ___________.______

Jurat/Affidavit Notary Public Certificate Stamp $27.00 $ ___________.______

NYS Notary Association Membership FREE MEMBERSHIP BY EMAIL Circle YES/NO $ 0.00

Framed Notary Public Diploma ( ) Black ( ) Walnut $37.70 (Copy of license required) $ ___________.______

Shipping and Handling UPS $12.00 For all Orders $ 12. 00

TOTAL AMOUNT $

For express shipping you may FAX this order form to (866) 413-4565 with the credit card info below. You may email usnotaryassociation@gmail.com/ Mail your order
and pay by credit card or checks/money orders with this form. Mail payable to: Shaimee Solutions, Inc., P.O. Box 586, Wappingers Falls, NY 12590

Last Name: ______________________________________________ First Name: _________________________________________

Shipping Address : Please check appropriate delivery address ( ) Residential ( ) Business Credit Card Billing Address if different from delivery Address:
(Business names required)
_____________________________________________________________________ _______________________________________________

_____________________________________________________________________ _______________________________________________

_____________________________________________________________________ _______________________________________________

Phone Number : __________________________________________ Email : _________________________________________________________ (please print clearly in CAPS!)

Credit card holder name (If paying with card only)___________________________________________________Type of credit card (Visa/MC/AMEX/Discover) __________________________

Card No. _____________________________________Expiration Date: ____________ CVV Code: _____________ Cardholders Signature : ____________________ Date: ___________

NOTE: ALL ORDERS FOR STAMPS AND SEALS REQUIRE A COPY OF LICENSE OR OLD STAMP. (For descriptions see www.NotaryPublicNewYork.com)