STATE OF CALIFORNIA …

STATE OF CALIFORNIA                                                                                                               OFFICE OF STATE PUBLISHING
STATE AGENCY ORDERS FOR SAM PRODUCTS
OSP 233 (Rev. 03/2007)


                                                              Ordering Instructions

Type or print information and fax the completed form to (916) 322-1014, or mail to:

                                                        Office of State Publishing
                                                        Administrative/SAM Unit
                                                        344 North 7th Street
                                                        Sacramento, CA 95814-0212 (IMS P-6)

For customer service, contact the Office of State Publishing's SAM Unit at (916) 327-8908, or e-mail: SAMUNIT@dgs.ca.gov

                                                                                                                   DATE MAILED:


         EXPENDITURE AUTHORIZATION                                                                         SHIP TO

    Your order cannot be processed without your                 NAME (First, Last)
    billing code and an authorizing signature.
    Please contact your accounting office if you are            WORKING TITLE
    not sure of your agency billing code.

                    5-Digit Billing Code                        AGENCY or DEPARTMENT

                                                                DIVISION
     ________ ________ ________ ________ ________
AUTHORIZING OFFICER'S PRINTED OR TYPED NAME                     SHIPPING ADDRESS (Number and Street--Unable to mail to P.O. Boxes)


AUTHORIZING OFFICER'S SIGNATURE (Required)                      (City, State, Zip Code--IMS code required for all agencies within the IMS system.)


                                                                TELEPHONE NUMBER (include Area Code or enter `8' if CALNET)
                                                                (        )
                                                                FAXIMILE NUMBER
                                                                (       )
                                                                E-MAIL ADDRESS



               PRODUCT DESCRIPTION                                      QUANTITY                       *PRICE EACH                             TOTAL
                                                                      (Must Be Entered)

State Administrative Manual (SAM)­Paper                                                                     $250.00

**Annual SAM Revision Subscription­Paper                                                                    $130.00

***SAM Binders (3 recommended)                                                                           $30.00 each
                                                                                                           GRAND
                                                                                                           TOTAL                     $
*   Price includes handling and shipping. Prices subject to change.

** This is a one-year subscription for SAM revisions, which also entitles customers to SAM Management Memos. Subscription renewal notices will be
   sent to customers 45 days prior to subscription expiration. State agencies will be automatically billed to renew Rev. subscriptions, unless the agency
   notifies OSP to discontinue the subscription.

*** Official 3 ½" SAM binders are hinged and made of durable vinyl. The SAM can be placed into two binders, but the use of three binders is
    recommended for frequent use.

                         Access the SAM and SAM Management Memos on the Internet at: http://www.osp.dgs.ca.gov
                                      (Note: The SAM electronic (Internet) publications are the official references.)

                                                                          OSP Use Only
    DATE DOCUMENTS FILED/INITIALS                      DATE POD SYSTEM UPDATED/INITIALS                            DATE SAM SYSTEM UPDATED/INITIALS




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