IRDPrint OnSight Order Form: New Customers


Please complete and submit this form. A Rosetta sales representative will call for your card information and to confirm the order.
* First Name	First Name is required.
* Last Name	Last Name is required.
* Company	Company name is required.
* Phone	Phone number is required.
* Email	Email is required.
* Billing Address	Billing Address is required.
Billing Address 2
* Billing City	Billing City is required.
* Billing State	Billing State is required.
* Billing Zip	Billing Zip code is required.
* Shipping Address	Shipping Address is required.
Shipping Address 2
* Shipping City	Shipping City is required.
* Shipping State	Shipping State is required.
* Shipping Zip	Shipping Zip code is required.
* Full Name on Card	Full Name on Card is required.
PO #
Please Enter the Quantity of IRDPrint OnSight and Supplies
IRDPrint OnSight DN \| $899.00
MICR Toner Replacement Cartridge (5k yield) \| $199.00
24lb. IRD Security Paper (1 case of 2500 sheets) \| $59.00
Extra printer drawer, 250 sheets \| $199.00
System Enhancements
IRDPrint OnSight User License \| $399.00 (extra software license)
Backup SP 3410DN MICR printer \| $499.00
X9 File Explorer Single User License \| $499.00
IRDPrint View and Reprint Single User License \| $499.00
Express Exchange Warranty 2-Year Upgrade \| $249.00 (Provides total of 2-years coverage)
Express Exchange Warranty 3-Year Upgrade \| $409.00 (Provides total of 3-years coverage)
Sales Tax:
Exempt?	Yes No
Exemption certificates must be sent to Michele Gertz Email: MGertz@RosettaTechnologies.com Fax: 813-383-0248 Mail: Rosetta Technologies, Inc., 5912 Breckenridge Parkway, Ste. B, Tampa, Florida 33610.
Discuss any extra supply needs with your sales representative.

Please complete and submit this form. A Rosetta sales representative will call to confirm your information and order.
Terms of sale are Net 30 Days from the date of invoice. FOB ship point is Tampa, Florida. Freight charges are prepaid and added to all invoices unless specified otherwise on your purchase order. Remit address is: Rosetta Technologies, P.O. Box 864087, Orlando, FL 32886-4087 Sales tax will be charged as appropriate unless a valid copy of your exemption or resale certificate is provided before the date of shipping. For any questions please contact Mariclare Hahn at 1-800-937-4224, ext. 133.

Contact Information:
*First Name	First Name is required.
*Last Name	Last Name is required.
*Phone	Phone number is required.
Fax
* Email	Email is required.
Company Info:
*Company	Company is required.
* Billing Address	Billing Address is required.
Billing Address 2
* Billing City	Billing City is required.
* Billing State	Billing State is required.
* Billing Zip	Billing Zip Code is required.
* Shipping Address	Shipping Address is required.
Shipping Address 2
* Billing City	Shipping City is required.
* Shipping State	Shipping State is required.
* Shipping Zip	Shipping Zip Code is required.
* Website	Website is required.
* Federal ID #	Federal ID is required.
D&B #
* Year Est.	Year Est. is required.
* Employees	Employees is required.
PO #
Purchaser Information:
* Name	Name is required.
* Phone	Phone is required.
Fax
* Email	Email is required.
Accounts Payable Contact:

* Name	Name is required.
* Phone	Phone is required.
Fax
* Email	Email is required.
Email Tracking:
Email address for Emailing Invoices: *
	Email is required.
Email address for Tracking Information for Receiver: *
	Email is required.
Sales Tax:
Exempt?	Yes No
Exemption certificates must be sent to Michele Gertz Email: MGertz@RosettaTechnologies.com Fax: 813-383-0248 Mail: Rosetta Technologies, Inc., 5912 Breckenridge Parkway, Ste. B, Tampa, Florida 33610.
Bank Information:
* Bank Name	Bank name is required.
* Phone	Phone is required.
* Account #	Bank Account # is required.
* Contact	Bank Contact Name is required.
Please Enter the Quantity of IRDPrint OnSight and Supplies
IRDPrint OnSight DN \| $899.00
MICR Toner Replacement Cartridge (5k yield) \| $199.00
24lb. IRD Security Paper (1 case of 2500 sheets) \| $59.00
Extra printer drawer, 250 sheets \| $199.00
System Enhancements
IRDPrint OnSight User License \| $399.00 (extra software license)
Backup SP 3410DN MICR printer \| $499.00
X9 File Explorer Single User License \| $499.00
IRDPrint View and Reprint Single User License \| $499.00
Express Exchange Warranty 2-Year Upgrade \| $249.00 (Provides total of 2-years coverage)
Express Exchange Warranty 3-Year Upgrade \| $409.00 (Provides total of 3-years coverage)

Discuss any extra supply needs with your sales representative.

IRDPrint OnSight Order Form

Please complete and submit this form. A Rosetta sales representative will call for your card information and to confirm the order.

Please Enter the Quantity of IRDPrint OnSight and Supplies

Please complete and submit this form. A Rosetta sales representative will call to confirm your information and order.

Please Enter the Quantity of IRDPrint OnSight and Supplies