Letterhead Request Form

Today’s Date
(please use mm/dd/yy format):
 
Contact Name:
Tel:
Fax:
Dept Head/Principal Investigator:
Charge to Acct No:
Unit: Dept: Object: Source:
 
Student ID No.:
 
Evans Medical Foundation
Address:
Tel:
Fax:
 

NOTE: This form is NOT applicable for BMC purchase orders.

Delivery
 
All deliveries are made to the Educational Media Center, B500,unless a special request is made.
 
  Special Delivery Request:
Contact:
Tel.:
Location:
 

BU Letterhead option
School of Medicine (MED)
Goldman School of Dental Medicine (SDM)
School of Public Health (SPH)
Medical Campus (MED CAMPUS)
School of Medicine/Boston Medical Center (MED/BMC)
Affiliation with Veterans Affairs (MED/VA)
Other Affliation (with permission from Corporate Communications, tel: 638-8491)

BMC Letterhead Option
NOTE: Joint or Chief/Chair letterhead is avaliable if paying by BU source code or Evans Medical Foundation Funding.
Joint (BMC/MED)
Chief/Chair(Exclusively for individuals with both
Chief/BMC and Chairman/MED appointments)
 

Letterhead Information
Name:
Title:
School Affiliation:
Department:
Address:
City, State, Zip:
Tel:
Fax:
Pager:
Cell:
Email:
Website:
 
Quantity
500 (minimum order)
1000
2000
5000
Other:
 

Special Instructions/
Additional Information:

 

To send examples of current letterheads, either fax to (617) 638-8289,
or email services.emc@bumc.bu.edu,
with the subject line ‘letterhead’

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