THANKS FOR YOUR BUSINESS

Department of the Interior
Office of the Secretary
National Business Center
(Name of NBC Division)
1849 C Street, NW, Mailstop (1366)
Washington, DC 20240
(Telephone #202-208-5638)

INVOICE # NBC/(EPS)2000-1 (use NBC Division acronym)

Date:____________

Customer/Agency Name:

Address:

Contact:

Telephone:

Description of Service(s):

Total Cost:

Payment by Credit Card: American Express; Mastercard; Visa; Discover; Diners Club (circle one)

Card Number:
Card Holder Name:
Card Holder Billing Address:

Card Expiration Date:
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DOI/NBC/(EPS) Account Number:

THANKS FOR YOUR BUSINESS