New Jersey Department of Health

REQUISITION FOR PRINTING AND GRAPHIC DESIGN
Printing and Graphic Design Use Only
Received:	__________________

Control #:	__________________

Graphics #:	_________________

Assigned To:	________________
Department Submitting Request (check only one):

Health Human Services Agriculture Transportation

Other: _______________

instructions for NJDOH USERs:

Requests for forms, certificates, letterhead and envelopes should be forwarded directly to Forms Control and Records Management (FCRM), PO Box 360, along with one (1) sample of the item to be printed.

All other requests should be forwarded directly to Printing and Graphic Design, Room B-10, Health-Agriculture Building, PO Box 360, along with one (1) sample of the item to be printed. Requests can be accepted electronically and may be emailed to print.graphicdesign@doh.nj.gov.

Review by the Office of Communications is required for all printed items that will be distributed to the public, and an approved OC-13 must accompany the PG-1 form. Approval is required even for “Exact Repeats.”

ADDITIONAL general INSTRUCTIONS FOR all users:

Original documents, not photocopies or scans, are required for printing. If item is available in electronic format, please forward with PG-1 form.

If a price quote was previously obtained, please include it with the PG-1 form.

Type Request

Request Submitted Date

Requested Delivery Date

Form No.

Project for

[ ] Permanent Use

[ ] One-Time Use
Printing Control # (G,C,H,J#)

Project Title

OC-13 Form Required?

No

Yes - Attached
Quantity

[ ] Business Cards (attach PG-2 for each name)

[ ] Certificates/Awards

[ ] Tent Signs: [ ] Blank [ ] DOH Logo [ ] State Seal	[ ] Envelope: PO Box: _______

Size/Type:

Color: ________________
Number of Pages

(1 side=1 page)

Finished Size

Paper Type and Color

[ ] Plain Bond [ ] Cover [ ] NCR- Parts

[ ] Paper Color (if not white): ___________

[ ] Cover Color (if not white): ___________	Ink Color

[ ] Black

[ ] Other Color: ___________

[ ] Full Color

[ ] Single Sided

[ ] Double Sided
Finishing

[ ] Collate/Staple	[ ] Punch: holes	[ ] Laminate	[ ] Velobind Color:

[ ] Collate/Slipsheet	[ ] Shrink Wrap: /Pack	[ ] Mount on Poster Board	[ ] Spiral Bind Color:

[ ] Fold	[ ] Pad: /sheets per pad	[ ] Framing (if available)	[ ] Tape Bind Color:

[ ] Perforate	[ ] Mail Merge	[ ] Saddle Stitch (booklet staple)
Special Instructions

PRINTING AND GRAPHIC DESIGN USE ONLY
EOM

Digital

Black Imp	__________ x ___________ = $____________

Color Imp	__________ x ___________ = $____________

Color Imp	__________ x ___________ = $____________

Subtotal Imp ____________

Offset

Imp	__________ x ___________ = $____________

Imp	__________ x ___________ = $____________

Subtotal Imp ____________

Imp Total ____________

Printing Total	$____________

Stock	$____________

Binding	$____________

Other	$____________

Graphics Total	$____________

Grand Total	$____________
Account Number
FY	Fund	Agency	Org.	Appr.	Acct.	Object	Rpt Cat
Funds Approved By (Print):
Funds Approved By (Signature):
Division:
Program:

Requested By:
Person to Approve Proof:
Telephone Number (Required):	Notes
[ ] Delivery	OR	[ ] Pick-up
Delivery Location:

Completed By	Date
PG-1

DEC 16

PG-1, Requisition for Graphic Arts and Printing

PG-1 (formerly P&G-1), Requisition for Graphic Arts and Printing, printing request, graphic arts and printing, print shop, print, graphics, printing

EWhite

2016-08-17

NJDOH