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01/11/2011 TUE 12:23 FAA <br />60001/001 <br />TECHNICAL ASSISTANCE FOR EMPLOYERS <br />800 NE Oregon Street, Suite 1045 a Portland a Oregon 97232 <br />Phone: 971.673.0824, Fax: 971.673-1384 BOLI <br />101, <br />please fill out this form completely and fax or mail it to the address listed above. Don't forget to include your Shipping/Handling <br />fee to avoid any delay in processing your order. Please allow 2.3 weeks for delivery. Publications are also available for purchase <br />at our field offices in Portland, Salem and Eugene. <br />Business Name: <br />Attention: C~ S4 C,~ 16 <br />Mailing Address: I 15- 73 ldaAr. <br />Cfty/Statelzip: e <br />Telephone: S L1l 1 9- - 5 L r) <br />E-Mall Address: ) 0:4.L y ( Wja <br />Guidelines <br />commonly xequirea rostmgs in Oregon (8-in-1) poster- English for 2011 I $10 <br />for employers with 15 or more employees to Oregon <br />Commonly Required Postings in Oregon (8-in-1) poster-Spanish for 2011 <br />$10 <br />Fnr ewrnrm.nro .nr~l. ~ c ,..e a.,...1......,..:. n- <br />Commonly Required Postings in Oregon (6-in-1) poster- English for 2011 $10 <br />for employers with 24 or fewer employees in Oregon <br />Commonly Required Postings in Oregon (6-In-1) poster - Spanish for 2011 $IO <br />for employers with 24 orfeiver employees in Oregon <br />Postings for Employers In Agriculture (I 1-In-1) nester (bi-Ilnauah for 2011 <br />Shi in 8r Handlin Costs: <br />Total order up to $10 <br />Orders $10.01 to $50 <br />M <br />Orders $50.01 to $100 <br />Orders $100.01 and over <br />Total Cost / J. <br />$20.00 <br />Shi In /Handlin cacao <br />Total Amount Due o , o0 <br />To avoid delay in order processing, be sure to include Shipping & Handling cost******** <br />PAYMENT METHOD: Q Check 0 Purchase Order P. <br />❑ VISA MasterCard (no other credit cards accepted) <br />Credit Card Number: 5110- <9 `3-U d 1~ 15 `6 (o(0 <br />1 <br />Expiration Date: 0g ) a-O t ) <br />Printed Name: `rt^u ~cc 1 S <br />Authorized Signature: .,0~ / <br />