ORDER FORM
Des Moines Stamp Mfg. Co.
851 6th Ave., P.O. Box 1798
Des Moines, IA 50306
Phone: 800-782-6763  Fax: 888-236-7739

Simply print order form, fill out and fax or mail to Des Moines Stamp

Perma Stamp pre-inked stamps*
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 Inspection Stamps
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All rubber 
Cast Aluminum
Perma-Pencil *
Perma-Insp. *
QD (black, red, blue)
Self Inking *		 Heavy Duty Stamps
Quantity_____
Dater (Red/Blue) 
Stamper (Black)
Dater only (Black)

* Choose Color below (Circle or Select)
Black  Red Blue Green  Purple

Print information for stamp(s) below:

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