PCISSC Small Merchant Guide Order Form V05

PCISSC_Small_Merchant_Guide_Order_Form_-v05

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PCI Security Standards Council, LLC
401 Edgewater Place, Suite 600 • Wakefield, MA USA 01880
Phone: +1-781-876-8855 (Option 2) • Fax: +1-781-623-1063
www.pcisecuritystandards.org

PCI SMALL MERCHANT REFERENCE GUIDE ORDER FORM
First & Last Name:
Title:
Company:
Address:
Email:

Phone:

Ship to address (Please complete this section if ship to address is different from above billing address. We cannot ship to PO Boxes.):

Quantity Information

20–49 (20 is the minimum order amount)

$10.50 each

50–100

$9.00 each

101–1000

$7.25 each

1001+

$6.25 each

Customized Co-branded Orders (1000+)

$7.75 each

Customized Co-branded E-version (PDF)

$125.00

Shipping and handling are included.

Quantity

Shipping &
handling

Price per piece

$

$

TOTAL
INVOICE

$

Included

If you have any questions, please contact +1-781-876-8855 (Option 2).
To order a custom printed version (orders of 1000+) or a digital, E-version in PDF format, co-branded with your company logo you will
need to supply us with your logo in a print-ready file format (such as .ai .eps, .jpg, .pdf, .ps, .psd, .tif; color mode: CMYK; resolution:
300dpi). Please email the logo to pcispeaking@pcisecuritystandards.org.
Payment Options:
Invoice Me

Card Type:

Billing Contact:

Card Number:
Expiration Date:

Billing ZIP Code:

Billing Address:

Name on Card:
Signature:

Please fax this completed form to +1-781-623-1063*. Thank you.

* This is a secured fax line.
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