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PLEASE LIST QUANTITY NEXT TO BOOK CHOICE

BEST SELLER! ________ OUCH REPORT ________ CHILD BEHAVIOR REPORT

________ DAILY DIAPER LOG AFTER HOURS LATE ________ FEE RECEIPT

________ TOTAL NUMBER OF BOOKS ORDERED (2 Book Minimum)

Superior Quality, Experience & Service

FREE design!

FREE logo!

FREE proof!

PAYMENT METHOD

CHECK ENCLOSED Check #____________________ CREDIT CARD Visa MasterCard AmEx Discover

Card #Name of Cardholder

(3-4 digit # on Security # back of card)

Name of CardholderAuthorized Signature

Contact Person

Date

School NameStreet AddressCity State ZIP

Phone FAX

2 Books + Shipping .............................................$80 4 Books + Shipping ........................................... $115 6 Books + Shipping ...........................................$156 8 Books + Shipping ...........................................$196 12 Books + Shipping ...........................................$258

Order Any Mix of the Pre-Printed Specialty Day Care

books for a Package Price!Orders with NO COPY CHANGES can ship in 48-hours.Four Reports per page — 250 per book — Duplicate Forms.

SPECIALTY BOOK ORDER FORM

For specialty books requiring custom imprint information such as name, address, etc., please refer to the receipt book pricing.

Mail completed form with payment to: Superior Receipt Book Co. & Printing Services, PO Box 326, Centreville, MI 49032-0326

www.receipts.com • [email protected] • 800.624.2887 • fax 269.467.4541For more information on any of our many products please contact CUSTOMER SERVICE today! 800.624.2887

DAY CARE SPECIALTY BOOKS

OUCH REPORTChild’s Name________________________________ Date__________

It Happened___________________ inside_________outside ____________timeBrief Description of Injury___________________________________________________________________________________________________________First Aid____washed______bandaid_____ice_____rest/observation_______T.L.C.Person Attending the Injury______________________Other Witness_________Director___________________ Additional Comments______________________________________________________________________________________

"OUCH REPORT" — Our Day Care professionals love this form! When the need arises to report a child’s boo-boo, the person attending the injury and what first aid was given... this form is ready to go. So easy to use and convenient too!

"CHILD BEHAVIOR REPORT" — Informs the parents of their child’s disposition and what action was needed to resolve the issue or if a meeting is required.

Daily Diaper Log / Activities Your Child’s Needs

7am 8am 9am 10am 11am 12pm 1pm 2pm 3pm 4pm 5pm 6pm otherDiaper Changes:

D=Dry BM=Bowel Movement W=Wet T=ToiletTime Slept:___________to___________Activities:_____________________________________________________________________________Meals_________________________ ___________________________ __________________________Something to make you smile:_______________________________________________________________Your Child needs:__________ Diapers_________Wipes________Change of Clothes_______ Other_________

Child’s Name:__________________________________________________ Date___________

Date:__________________________Time of Pick-Up:________________Parents Name____________________________________________________________Child(ren) Name _________________________________________________________Late Fee - - $_________________ Rate $ ___________________________________Other Fees $_________________ For:_____________________________________Amount Due $_________________Staff Signature___________________________________ Parent Signature____________________________________

“After Hours” Late Fee Receipt

"DAILY DIAPER" Log/Activities — Perfect for parents to know exactly what diaper changes were needed during the day. Also record nap time, meals and if clothing changes were made.

"AFTER HOURS" Late Fee Receipt — Tracks parents tardiness and payment assessed. Charge the tardy parents the money you earned for your overtime.

Child ___________________________________________________ Date __________Today your child was Happy and Fun. He /She did the following _____________________________________________________Today your child was UnHappy for the following reason_______________________________________________________________________We took the following action _________________________________________________Please set aside a few moments to discuss the following issues; � Interaction with others � Appetite � Rest � Your Childs needs � Other_____________________________� Please plan to meet at your earliest convenience. � Please call ASAP _______________

This report was prepared by_______________________________ Date______________

Child Behavior Report

MIX + MATCH FOR 1 LOW PRICE!

BEST SELLER!

SUPERIOR

R EC E I PT B OO K C O M PA N Y

& P r int ing S e r v i c e s

Date ____________________ Numbers From __________ to __________

215 South Clark Street, P.O. Box 326

Centreville, MI 49032

(269) 467-8265 • (800) 624-2887

24-Hour Fax (269) 467-4541 • www.receipts.com

800.624.2887

215 S. CLARK STREET • CENTREVILLE, MI 49032

SUPERIOR

R EC E I PT B OO K C O M PA N Y

& P r int ing S e r v i c e s


269.467.8265 • 800.624.2887

www.receipts.com

DATE . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Received from ____________________________________________________________________

____________________________________________________________Dollars $ . . . . . . . . . . . . . . . . . . .

Child’s Name: ____________________________________________________________________

AMOUNT OF ACC’T $ . . . . . . . . . . . . . . . . . . . . . . . . . . . .______________________________________________________________

AMOUNT PAID$ . . . . . . . . . . . . . . . . . . . . . . . . . . . .

BALANCE DUE$ . . . . . . . . . . . . . . . . . . . . . . . . . . .

THANK

CASH ( ) CHECK ( ) OTHER . . . . . . . . . . . . YOU!By . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

BABY’S DAY CARE

DAY CARE � NITE CARE � WE CARE

215 SOUTH CLARK STREET - CENTERVILLE, MI 49032

PHONE: (800) 624-2887FAX: (467) 467-4541

BABY’S DAY CARETAX I.D. #12-345678

1001

DATE . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Received for (Child’s Name) _______________________________________________

Week of ____________________________ Amount $ . . . . . . . . . . . . . . . . . . . . . .

TOTAL THIS MONTH $ . . . . . . . . . . . . . . . . . . . . . . . . . . . .

PAID

$ . . . . . . . . . . . . . . . . . . . . . . . . . . . .

BALANCE DUE$ . . . . . . . . . . . . . . . . . . . . . . . . . . .

CASH ( ) CHECK #_______________________

THANK YOU!

ANGEL’S DAY CARE

WE TAKE CARE OF YOUR ANGEL’S

215 SOUTH CLARK STREET - CENTREVILLE, MICHIGAN 49032

PHONE: (800) 624-2887 - FAX: (269) 467-4541 - www.receipts.com

“All thy children shall be taught of the Lord and great shall

be the peace of thy children” (Isaiah 54:13)

PREVIOUS BALANCE $ . . . . . . . . . . . . . . . . . . . . . . . . . .

By. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1002

DATE . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Received from ____________________________________________________________________

Child’s Name: ____________________________________________Dollars $ ________________

( ) Registration ______________( ) Tuition _______________( ) Field Trip______________

AMOUNT OF ACC’T $ . . . . . . . . . . . . . . . . . . . . . . . . . . . .______________________________________________________________

AMOUNT PAID$ . . . . . . . . . . . . . . . . . . . . . . . . . . . .

BALANCE DUE$ . . . . . . . . . . . . . . . . . . . . . . . . . . .

THANK

CASH ( ) CHECK ( ) OTHER . . . . . . . . . . . . YOU!By . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

JERRY’S KIDS EARLY LEARNING CENTER

“A FUN PLACE TO PLAY AND LEARN”

215 SOUTH CLARK STREET

CENTREVILLE, MICHIGAN 49032

PHONE: (800) 624-2887 - FAX: (269) 467-4541

JERRY’S KIDS EARLY LEARNING CENTER

TAX I.D. #12-3456789

1003

DATE . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Received from ____________________________________________________________________

____________________________________________________________ Dollars $ . . . . . . . . . . . . . . . . . .

Name of Child(ren): __________________________________________________________________

For child care services from______/_____/_____to _____/_____/____ Provider’s SS# or Taxpayer ID# _______________

AMOUNT OF ACC’T $ . . . . . . . . . . . . . . . . . . . . . . . . . . . . CASH ( )

AMOUNT PAID$ . . . . . . . . . . . . . . . . . . . . . . . . . . . . CHECK ( )

Provider’s Signature__________________________________

BALANCE DUE$ . . . . . . . . . . . . . . . . . . . . . . . . . . . . OTHER ( )

THANK YOU!

ABC LEARNING CENTER

215 SOUTH CLARK STREET - P. O. BOX 326

CENTREVILLE, MICHIGAN 49032

PHONE: (800) 624-2887 - FAX: (269) 467-4541

ABC LEARNING CENTER

Parent / Guardian Name

M D Y M D Y

1004

Superior Preschool215 South Clark StreetCentreville, MI 49032

(269) 467-8265Mrs. Johnson Head Teacher

EMPLOYEE BADGESFull Color Photos & Company Logos Security laminated staff I.D. Badges are a simple, efficient and effective way to ensure safety for your employees.

Starting at $10.00* a badge *Quantity discount

Call for information on how to place your order.

800.624.2887800.624.2887CALL TODAY! Our staff is ready to help YOU!

Or Order Online: www.receipts.com

ABC LearningCenter

215 South Clark StreetCentreville, MI 49032

(269) 467-8265

Jane Smith TEACHER ASSISTANT

Superior Receipt Book Company & Printing Services • 215 S. Clark St. • PO Box 326 • Centreville, MI 49032-0326

SELECT FROM AVAILABLE LOGOS (Please check the correct box)

CUSTOM LOGO SUPPLIED: Enclosed with Order Form Sent via Email to [email protected]

1 2 4 5 6

1910987

24

from this

CALL800.624.2887

RECEIPT BOOK ORDER FORM

SELECT QUANTITY AND TYPE (Please check the correct boxes)NOW OFFERING CUSTOM COVERS! Quantity Discounts available. Call 800.624.2887

2 books $132.24 Add logo cover + $11.12







DUPLICATE (250/book) TRIPLICATE (180/book)

TOTAL THIS ORDER $_______________

Format: DC1002

Format: DC1003

Format: DC1004

Format: DC1005

Format: DC1006

AVAILABLE FORMATSFormats can be customized with your changes at NO CHARGE!

Format: DC1001

PROOF REQUIRED (Please check the correct box)

1st and 2nd Proofs are free — additional are $7 per revision

YES! Email to: No proof neededContact Person

Date

Business NameSlogan

Street AddressCity State ZIP

Phone FAX

Starting @ Number:____________________________(IF LEFT BLANK, 1001)

CHOOSE FROM ONE OF SIX FORMATS:

Receipt books come with 4 receipts per page, are available as duplicate (250 per book) or triplicate (180 per book), measure 7 5/8" x 2 3/4"

and have a 7/8" bound tear-off on the left.

Mail completed form with payment to: SUPERIOR RECEIPT BOOK CO. & Printing Services

PO Box 326, Centreville, MI 49032-0326www.receipts.com • [email protected] • 800.624.2887 • fax 269.467.4541

SELECT FORMAT (Please check the correct box)

DC1001 DC1002 DC1003 DC1004 AT1005 DC1006 DCIN1007 (Custom Format or provide your own sample)

PAYMENT METHOD

CHECK ENCLOSED Check #____________________

CREDIT CARD Visa MasterCard AmEx Discover

Card #

Expiration Date(3-4 digit # on

Security # back of card)

Name of CardholderAuthorized Signature

DATE . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Received from ________________________________________________________________________________________________________________________________Dollars $ . . . . . . . . . . . . . . . . . . .

Child’s Name: ____________________________________________________________________AMOUNT OF ACC’T $ . . . . . . . . . . . . . . . . . . . . . . . . . . . . ______________________________________________________________

AMOUNT PAID $ . . . . . . . . . . . . . . . . . . . . . . . . . . . .

BALANCE DUE $ . . . . . . . . . . . . . . . . . . . . . . . . . . . THANKCASH ( ) CHECK ( ) OTHER . . . . . . . . . . . . YOU! By . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

BABY’S DAY CAREDAY CARE � NITE CARE � WE CARE

215 SOUTH CLARK STREET - CENTERVILLE, MI 49032PHONE: (800) 624-2887

FAX: (467) 467-4541

BABY’S DAY CARETAX I.D. #12-345678

1001

DATE . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Received for (Child’s Name) _______________________________________________Week of ____________________________ Amount $ . . . . . . . . . . . . . . . . . . . . . .

TOTAL THIS MONTH $ . . . . . . . . . . . . . . . . . . . . . . . . . . . .

PAID $ . . . . . . . . . . . . . . . . . . . . . . . . . . . .

BALANCE DUE $ . . . . . . . . . . . . . . . . . . . . . . . . . . .

CASH ( ) CHECK #_______________________ THANK YOU!

ANGEL’S DAY CAREWE TAKE CARE OF YOUR ANGEL’S

215 SOUTH CLARK STREET - CENTREVILLE, MICHIGAN 49032PHONE: (800) 624-2887 - FAX: (269) 467-4541 - www.receipts.com

“All thy children shall be taught of the Lord and great shallbe the peace of thy children” (Isaiah 54:13)

PREVIOUS BALANCE $ . . . . . . . . . . . . . . . . . . . . . . . . . .

By. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1002

DATE . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Received from ____________________________________________________________________Child’s Name: ____________________________________________Dollars $ ________________( ) Registration ______________( ) Tuition _______________( ) Field Trip______________AMOUNT OF ACC’T $ . . . . . . . . . . . . . . . . . . . . . . . . . . . . ______________________________________________________________

AMOUNT PAID $ . . . . . . . . . . . . . . . . . . . . . . . . . . . .


JERRY’S KIDS EARLY LEARNING CENTER“A FUN PLACE TO PLAY AND LEARN”

215 SOUTH CLARK STREETCENTREVILLE, MICHIGAN 49032

PHONE: (800) 624-2887 - FAX: (269) 467-4541

JERRY’S KIDS EARLY LEARNING CENTERTAX I.D. #12-3456789

1003

DATE . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Received from ________________________________________________________________________________________________________________________________ Dollars $ . . . . . . . . . . . . . . . . . .

Name of Child(ren): __________________________________________________________________For child care services from______/_____/_____to _____/_____/____ Provider’s SS# or Taxpayer ID# _______________

AMOUNT OF ACC’T $ . . . . . . . . . . . . . . . . . . . . . . . . . . . . CASH ( )

AMOUNT PAID $ . . . . . . . . . . . . . . . . . . . . . . . . . . . . CHECK ( ) Provider’s Signature__________________________________

BALANCE DUE $ . . . . . . . . . . . . . . . . . . . . . . . . . . . . OTHER ( ) THANK YOU!

ABC LEARNING CENTER215 SOUTH CLARK STREET - P. O. BOX 326

CENTREVILLE, MICHIGAN 49032PHONE: (800) 624-2887 - FAX: (269) 467-4541

ABC LEARNING CENTER


M D Y M D Y

1004

DATE . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Received from ________________________________________________________________________________________________________________________________Dollars $ . . . . . . . . . . . . . . . . . . .

In re: __________________________________________________________________________AMOUNT OF ACC’T $ . . . . . . . . . . . . . . . . . . . . . . . . . . . . ______________________________________________________________

AMOUNT PAID $ . . . . . . . . . . . . . . . . . . . . . . . . . . . .


CENTREVILLE COMMUNITY DAYCARE215 SOUTH CLARK STREET - P. O. BOX 326

CENTREVILLE, MICHIGAN 49032PHONE: (800) 624.2887 - FAX: (269) 467-4541

www.receipts.com - [email protected]

CENTREVILLE COMMUNITY DAYCARE

1005

DATE . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Received from ______________________________________________________________________Name of Child(ren): __________________________________________________________________( ) Registration ________________ ( ) Tuition _________________ ( ) Drop-In ________________For child care services from______/_____/_____to _____/_____/____ Tax I.D. # 12-3456789AMOUNT DUE $ . . . . . . . . . . . . . . . . . . . . . . . . . . . . CASH ( )

AMOUNT PAID $ . . . . . . . . . . . . . . . . . . . . . . . . . . . . CHECK ( ) Provider’s Signature__________________________________

BALANCE DUE $ . . . . . . . . . . . . . . . . . . . . . . . . . . . . OTHER ( ) THANK YOU!

MY FAMILY DAY CARE HOMEHOME AWAY FROM HOME

215 SOUTH CLARK STREET - P. O. BOX 326CENTREVILLE, MICHIGAN 49032

PHONE: (800) 624-2887 - FAX: (269) 467-4541

MY FAMILY DAY CARE HOME


M D Y M D Y

1006

DATE:____________________________

Received from________________________________________________Dollars $_____________

Child’s Name:____________________________Class Name: ______________________________

Memo: __________________________________________________________________________

REGISTRATION FEE:TUITION PAYMENT FOR WEEK BEGINNING___________________________________ ENDING ______________________________

PAYMENT ON TUITION ACCOUNT____________________________________________ BAL DUE _____________________________

THANK YOU! By ___________________________________________________

SUPERIOR WEEKDAY PRESCHOOL215 SOUTH CLARK STREET - P. O. BOX 326

CENTREVILLE, MICHIGAN 49032PH: (800) 624-2887 - FAX: (269) 467-4541

www.receipts.com - [email protected]

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: DC

1007

We can design your receipts, business forms and more!

to this

And add a …LOGO COVER!

We now offer covers for your receipt books with your name and

logo in full-color!800.624.2887

215 S. CLARK STREET • CENTREVILLE, MI 49032

SUPERIOR

R EC E I PT B OO K C O M PA N Y& P r int ing S e r v i c e s


269.467.8265 • 800.624.2887www.receipts.com

SUPERIOR WEEKDAY PRESCHOOL

to talk to a customer service representative about your business receipts & other printing needs

www.receipts.com • [email protected]

No hidden costs

Laser perforations

FREE design.FREE logo.FREE proof.

NEW! Beautiful full-color

logo covers

Placing your order is simple

and quick!

All receipts print on 20# high-quality carbonless

paper

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Envelopes to your order

day care specialty books - superior receipt book … · day care specialty books ... tuition paym...

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