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Self-Inking Dater Stamp Order Form


Contact and Billing Information:


Departmental Charge
P-Card
Debit/Credit

If you wish to use a P-Card or other debit/credit card you will be contacted for that payment information.
Please DO NOT email us your debit/credit information.

For information regarding ordering nameplates/signs or for questions about this form, contact:
[email protected] or [email protected] or call us at 515-294-8390.

Self-Inking Dater Stamp Information

Ink Color:*

Black
Blue
Red
Green

Stamp Size:*

Border:*

Yes
No

Quantity:*


(please include where type will be in conjunction with date:

Example:

RECEIVED
(date)
UBS

If you want ALL CAPS please type in ALL CAPS.)

Special Instructions:

Year Band Replacements:

You must send your dater to UBS for a year band replacement.

 
Item Count: 0
Sub-Total: $0.00
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