DA-104 Printing Requisition Form

Kansas Department of Administration, Division of Printing

DA 104 Printer Requisition

This electronic version of the Printer Requisition is suitable basic jobs. Jobs of greater complexity should be submitted on standard versions of this form. Please print a copy of the form confirmation page. After an estimate is prepared a copy of the DA 104 will be returned to your agency.

Please Note:Some agencies submit all printing requisitions through a centralized source. Please follow internal agency procedures for submitting work to the Division of Printing. All on-line requisitions will be authenticated prior to print production.

(Please: No Hard Returns when filling out this form)
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Agency Number:
*(required)
Agency Name:
*(required)
Billing Address:
*(required)
Shipping Address: (if different)

Contact Person:
*(required)
Phone Number:
*(required)
Fax Number:
*(required)
Email Address:
*(required)
Requested Due Date:

Last Previous Job Number:

No Changes:
With Changes:
New Job:
Clear Selections

Agency Requisition Number:

Pre-Estimate Number:

Publication Title:
*(required)
Quantity:
*(required)
Size:

Text Stock:

Cover Stock:

Text Ink:

Cover Ink:

Electronic File Name:

Send Proof: Address:
No Proof Necessary:
Clear Selection:

Imaging Options:
Type Set:
Camera Ready:
C. R. Disk:
Non C.R. Disk:
Clear Selection:

Binding Options:
Saddle Stitch:
Perfect Bind:
Loose Leaf:
GBC plastic:
Plasticoil:
Clear Selection:

Other Bindery Operations:
Fold:
Pad:
Fanapart:
Staple:

Other Instructions:

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