{"id":32,"date":"2004-08-23T12:21:13","date_gmt":"2004-08-23T16:21:13","guid":{"rendered":"https:\/\/www.bumc.bu.edu\/bumc-emc\/forms\/envelope-request-form\/"},"modified":"2004-08-23T12:21:13","modified_gmt":"2004-08-23T16:21:13","slug":"envelope-request-form","status":"publish","type":"page","link":"https:\/\/www.bumc.bu.edu\/bumc-emc\/forms\/envelope-request-form\/","title":{"rendered":"Envelope Request Form"},"content":{"rendered":"<form action=\"http:\/\/www.bu.edu\/phpbin\/telegraph\/\" method=\"post\" name=\"EnvelopeRequest\"><input type=\"hidden\" name=\"form_location\" value=\"\/cms\/telegraph\/\" \/><input type=\"hidden\" name=\"form_configuration\" value=\"config.direct.xml\" \/> <input type=\"hidden\" name=\"*smtphost\" value=\"acs-smtp.bu.edu\" \/> <input type=\"hidden\" name=\"to\" value=\"services.emc@bumc.bu.edu\" \/> <input type=\"hidden\" name=\"subject\" value=\"Request For Envelope\" \/><\/p>\n<table border=\"1\" width=\"100%\">\n<tr>\n<td>\n<table border=\"0\">\n<tr>\n<td><strong>Today&#8217;s Date<\/strong><br \/>\n(please use mm\/dd\/yy format): <input type=\"TEXT\" size=\"9\" maxlength=\"9\" name=\"date\" \/><\/td>\n<\/tr>\n<tr>\n<td>&nbsp;<\/td>\n<\/tr>\n<tr>\n<td><strong>Contact Name:<\/strong> <input type=\"TEXT\" size=\"20\" name=\"contact\" \/><\/td>\n<\/tr>\n<tr>\n<td><strong>Tel:<\/strong> <input type=\"TEXT\" name=\"tel\" \/><\/td>\n<\/tr>\n<tr>\n<td><strong>Fax:<\/strong> <input type=\"TEXT\" name=\"fax\" \/><\/td>\n<\/tr>\n<tr>\n<td><strong>Dept Head\/Principal Investigator:<\/strong><\/td>\n<\/tr>\n<tr>\n<td><input type=\"TEXT\" size=\"35\" name=\"PI\" \/><\/td>\n<\/tr>\n<tr>\n<td><strong>Charge to Acct No:<\/strong><\/td>\n<\/tr>\n<\/table>\n<table border=\"0\">\n<tr>\n<td>Unit:<\/td>\n<td><input type=\"TEXT\" size=\"3\" maxlength=\"3\" name=\"unit\" \/><\/td>\n<td>Dept:<\/td>\n<td><input type=\"TEXT\" size=\"3\" maxlength=\"3\" name=\"dept\" \/><\/td>\n<td>Object:<\/td>\n<td><input type=\"TEXT\" size=\"3\" maxlength=\"3\" name=\"obj\" \/><\/td>\n<td>Source:<\/td>\n<td><input type=\"TEXT\" size=\"5\" maxlength=\"5\" name=\"source\" \/><\/td>\n<\/tr>\n<tr>\n<td>&nbsp;<\/td>\n<\/tr>\n<\/table>\n<table border=\"0\">\n<tr>\n<td align=\"left\" colspan=\"33%\">Student ID No.: <input type=\"TEXT\" name=\"Student ID\" \/><\/td>\n<\/tr>\n<tr>\n<td>&nbsp;<\/td>\n<\/tr>\n<tr>\n<td colspan=\"33%\"><input type=\"CHECKBOX\" name=\"Evans Medical Foundation\" value=\"Evans Medical Foundation\" \/>Evans Medical Foundation<\/td>\n<\/tr>\n<tr>\n<td>Address:<br \/>\n<input type=\"TEXT\" name=\"Evans1\" \/><\/td>\n<\/tr>\n<tr>\n<td><input type=\"TEXT\" name=\"Evans2\" \/><\/td>\n<\/tr>\n<tr>\n<td align=\"left\" colspan=\"33%\">Tel: <input type=\"TEXT\" name=\"Evans3\" \/><\/td>\n<\/tr>\n<tr>\n<td align=\"left\" colspan=\"33%\">Fax: <input type=\"TEXT\" name=\"Evans4\" \/><\/td>\n<\/tr>\n<tr>\n<td>&nbsp;<\/td>\n<\/tr>\n<\/table>\n<p><strong><em>NOTE: This form is NOT applicable for BMC purchase orders.<\/em><\/strong><\/td>\n<\/tr>\n<\/table>\n<p><\/p>\n<table border=\"1\" width=\"100%\">\n<tr>\n<td>\n<table border=\"0\">\n<tr>\n<td><strong>Delivery<\/strong><\/td>\n<\/tr>\n<tr>\n<td>&nbsp;<\/td>\n<\/tr>\n<tr>\n<td colspan=\"3\">All deliveries are made to the Educational Media Center, B500,unless a special request is made.<\/td>\n<\/tr>\n<tr>\n<td>&nbsp;<\/td>\n<\/tr>\n<tr>\n<td>&nbsp;<\/td>\n<td colspan=\"2\" align=\"left\"><input type=\"CHECKBOX\" name=\"Delivery\" value=\"Delivery\" \/>Special Delivery Request:<\/td>\n<\/tr>\n<tr>\n<td align=\"left\">Contact:<\/td>\n<td><input type=\"TEXT\" name=\"contact2\" size=\"25\" \/><\/td>\n<\/tr>\n<tr>\n<td>Tel.:<\/td>\n<td><input type=\"TEXT\" name=\"tel3\" size=\"25\" \/><\/td>\n<\/tr>\n<tr>\n<td>Location:<\/td>\n<td>\n<textarea name=\"Location\" rows=\"5\" cols=\"20\"><\/textarea><br \/>\n<\/td>\n<\/tr>\n<tr>\n<td>&nbsp;<\/td>\n<\/tr>\n<\/table>\n<\/td>\n<\/tr>\n<\/table>\n<p><\/p>\n<table border=\"1\" width=\"100%\">\n<tr>\n<td><\/p>\n<table>\n<tr>\n<td><strong>BU Envelope option<\/strong><\/td>\n<\/tr>\n<tr>\n<td>\n<input type=\"RADIO\" name=\"BU Envelope Option\" value=\"School of Medicine\" \/> School of Medicine (MED)<\/td>\n<\/tr>\n<tr>\n<td><input type=\"RADIO\" name=\"BU Envelope Option\" value=\"Goldman School of Dental Medicine\" \/>Goldman School of Dental Medicine (SDM)<\/td>\n<\/tr>\n<tr>\n<td><input type=\"RADIO\" name=\"BU Envelope Option\" value=\"School of Public Health\" \/>School of Public Health (SPH)<\/td>\n<\/tr>\n<tr>\n<td><input type=\"RADIO\" name=\"BU Envelope Option\" value=\"Medical Campus\" \/>Medical Campus (MED CAMPUS)<\/td>\n<\/tr>\n<tr>\n<td><input type=\"RADIO\" name=\"BU Envelope Option\" value=\"School of Medicine\/Boston Medical Center\" \/>School of Medicine\/Boston Medical Center (MED\/BMC)<\/td>\n<\/tr>\n<tr>\n<td><input type=\"RADIO\" name=\"BU Envelope Option\" value=\"Affiliation with Veterans Affairs\" \/>Affiliation with Veterans Affairs (MED\/VA)<\/td>\n<\/tr>\n<tr>\n<td><input type=\"RADIO\" name=\"BU Business Envelope Option\" value=\"638-8491)\" \/>Other Affliation (with permission from Corporate Communications, tel: 638-8491)<\/td>\n<\/tr>\n<\/table>\n<\/td>\n<\/tr>\n<\/table>\n<p><\/p>\n<table width=\"100%\" border=\"1\">\n<tr>\n<td>\n<table>\n<tr>\n<td><strong>Envelope Information<\/strong><\/td>\n<\/tr>\n<tr>\n<td>\nName:<\/td>\n<td><input type=\"TEXT\" name=\"name2\" \/><\/td>\n<\/tr>\n<tr>\n<td>Title:<\/td>\n<td><input type=\"TEXT\" name=\"title\" \/><\/td>\n<\/tr>\n<tr>\n<td>School Affiliation:<\/td>\n<td><input type=\"TEXT\" name=\"affiliation\" \/><\/td>\n<\/tr>\n<tr>\n<td>Department:<\/td>\n<td><input type=\"TEXT\" name=\"dept2\" \/><\/td>\n<\/tr>\n<tr>\n<td>Address:<\/td>\n<td><input type=\"TEXT\" name=\"address\" \/><\/td>\n<\/tr>\n<tr>\n<td>City, State, Zip:<\/td>\n<td><input type=\"TEXT\" name=\"citystatezip\" \/><\/td>\n<\/tr>\n<tr>\n<td>Tel:<\/td>\n<td><input type=\"TEXT\" name=\"tel2\" \/><\/td>\n<\/tr>\n<tr>\n<td>Fax:<\/td>\n<td><input type=\"TEXT\" name=\"fax2\" \/><\/td>\n<\/tr>\n<tr>\n<td>Pager:<\/td>\n<td><input type=\"TEXT\" name=\"page\" \/><\/td>\n<\/tr>\n<tr>\n<td>Cell:<\/td>\n<td><input type=\"TEXT\" name=\"cell\" \/><\/td>\n<\/tr>\n<tr>\n<td>Email:<\/td>\n<td><input type=\"TEXT\" name=\"email\" \/><\/td>\n<\/tr>\n<tr>\n<td>Website:<\/td>\n<td><input type=\"TEXT\" name=\"website\" \/><\/td>\n<\/tr>\n<\/table>\n<table>\n<tr>\n<td>&nbsp;<\/td>\n<\/tr>\n<tr>\n<td><strong>Quantity<\/strong><\/td>\n<\/tr>\n<tr>\n<td><input type=\"RADIO\" name=\"Quantity\" value=\"500\" \/>500 (minimum order)<\/td>\n<\/tr>\n<tr>\n<td><input type=\"RADIO\" name=\"Quantity\" value=\"1000\" \/>1000<\/td>\n<\/tr>\n<tr>\n<td><input type=\"RADIO\" name=\"Quantity\" value=\"2000\" \/>2000<\/td>\n<\/tr>\n<tr>\n<td><input type=\"RADIO\" name=\"Quantity\" value=\"5000\" \/>5000<\/td>\n<\/tr>\n<tr>\n<td>Other:<input type=\"TEXT\" name=\"Other\" \/><\/td>\n<\/tr>\n<tr>\n<td>&nbsp;<\/td>\n<\/tr>\n<\/table>\n<\/td>\n<\/tr>\n<\/table>\n<p><\/p>\n<table width=\"100%\" border=\"1\">\n<tr>\n<td>\n<table>\n<tr>\n<td>\n<strong>Special Instructions\/<br \/>\nAdditional Information:<\/strong><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td>\n<textarea name=\"Instructions-Additional\" rows=\"5\" cols=\"15\"><\/textarea><br \/>\n<\/td>\n<\/tr>\n<tr>\n<td>&nbsp;<\/td>\n<\/tr>\n<\/table>\n<\/td>\n<\/tr>\n<\/table>\n<p>\nTo send examples of current envelopes, either fax to (617) 638-8289,<br \/> or email <a href=\"mailto:services.emc@bumc.bu.edu\">services.emc@bumc.bu.edu<\/a>,<br \/>\nwith the subject line &#8216;envelope&#8217;<\/p>\n<p>\n<input type=\"submit\" name=\"*Submit\" \/> <input type=\"reset\" value=\"Reset Form\" name=\"*Reset\" \/><\/p>\n<p>\n<a href=\"https:\/\/www.bumc.bu.edu\/bumc-emc\/\">Return to EMC<\/a> | <a href=\"https:\/\/www.bumc.bu.edu\/bumc-emc\/forms\/\">Return to Online Forms<\/a><\/p>\n<p><\/form>\n","protected":false},"excerpt":{"rendered":"<p>Today&#8217;s Date (please use mm\/dd\/yy format): &nbsp; Contact Name: Tel: Fax: Dept Head\/Principal Investigator: Charge to Acct No: Unit: Dept: Object: Source: &nbsp; Student ID No.: &nbsp; Evans Medical Foundation Address: Tel: Fax: &nbsp; NOTE: This form is NOT applicable for BMC purchase orders. Delivery &nbsp; All deliveries are made to the Educational Media Center, [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":26,"menu_order":6,"comment_status":"closed","ping_status":"closed","template":"","meta":[],"_links":{"self":[{"href":"https:\/\/www.bumc.bu.edu\/bumc-emc\/wp-json\/wp\/v2\/pages\/32"}],"collection":[{"href":"https:\/\/www.bumc.bu.edu\/bumc-emc\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.bumc.bu.edu\/bumc-emc\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.bumc.bu.edu\/bumc-emc\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.bumc.bu.edu\/bumc-emc\/wp-json\/wp\/v2\/comments?post=32"}],"version-history":[{"count":0,"href":"https:\/\/www.bumc.bu.edu\/bumc-emc\/wp-json\/wp\/v2\/pages\/32\/revisions"}],"up":[{"embeddable":true,"href":"https:\/\/www.bumc.bu.edu\/bumc-emc\/wp-json\/wp\/v2\/pages\/26"}],"wp:attachment":[{"href":"https:\/\/www.bumc.bu.edu\/bumc-emc\/wp-json\/wp\/v2\/media?parent=32"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}