This form must be completed and approved by you manager in order to be processed. Please allow 2-4 weeks processing time for your new cards or badge. Thank you! Questions? Contact Nikki Stewart, Communications Coordinator, at ext. 128.

Name Badge Only Order Form

Complete this form if you are ONLY ordering a name badge.

2 Internal: Name Badge Form

If you are human, leave this field blank.

Department * CNA School Communications/ Marketing Independent Living Home Health Human Resources Administrative/ Executive

Name of Requestor *

This may or may not be the person whose name will appear on the badge.

Full Name (as it will appear) *

Name as it appears here will be how it appears on the name badge.

Job Title (as it will appear) *

Title as it appears here will be how it appears on the name badge.

Additional Instructions

Business Card Order Form

Complete this form if you are ordering business cards. If you also want to order a name badge, check the appropriate circle.

2 Internal: Business Card and Name Badge Form

If you are human, leave this field blank.

Department * CNA School Communications/ Marketing Independent Living Home Health Human Resources Administrative/ Executive

Choose One: *

New Cards

Re-order

Quantity *

250

500

Order a Name Badge Also? *

Yes

No

Name of person submitting this request *

Full Name (as it will appear) *

If you are also ordering a name badge, name as it appears here will be how it appears on the name badge.

Full title (as it will appear) *

Email address (as it will appear) *

Standard format on cards is @the-ic.org [as opposed to theindependencecenter.org]

Phone number (as it will appear) *

Enter your direct dial phone number or just your extension if you prefer to use your extension.

Cell phone number (as it will appear)

Only add this if you want your cell phone number to appear on the card

Which fax number do you want used? *

General: 719-471-9322

Home Health: 719-471-7829

Human Resources: 888-247-4471

Additional information or Instructions