CupBoard Coupons
820 W.17^th St. Suite 1
Bloomington, IN. 47404
812-961-0292/812-272-8869
E-mail: click here office@cupboardcoupons.com

Customer: ________________________ Business Name: ________________________
Address: _________________________ Phone: ________________ Fax: ________________
City: _____________________ State: ______ Zip: _________ E-mail ___________________

We agree to purchase ____________ coupons from CupBoard Coupons for ______________________________________.

Included in this contract are the following:

Local business coupons

Print orders will be in full color
Minimum order of 50 coupons

Logo Sent:

Offer:

Number of Coupons	Number of sheets	Total Cost	Amount Paid

Date special starts: __________________ Date coupons are to be delivered ___________

Payments: Check ________ Credit Card: MC/Visa, Discover, Am Ex, PayPal

Credit card number:_____________________________ CVV _________ Expires ___________

Exact Name on Credit Card ____________________________________________________

Any other special considerations or alterations must be in writing and attached to this contract with the signature

of the authorizing business and the CupBoard Coupons Representative.

_____________________________ __________________________________
Client Please Print CupBoard Representative