PURCHASE ORDER - DISTRICT COURT FORMS
Ship To: Telephone No:
Contact person:
Date:
NOTE: District Court forms are subject to unscheduled and unannounced re
visions
. We suggest you purchase no more than
a three (3) month supply. We will not provide refunds or free replacements if the previous version becomes outdated.
INSTRUCTIONS: Use this purchase order to order forms which do not appear on our Civil Forms Purchase Order (Form DCA-
040). List the form numbers and number of packages requested below. (some District Court forms are also available on the Judiciary
website at: mdcourts.gov/district/dctcivforms
CHARGES: Expect for those specific forms listed on Purchase Order DCA-040, the cost for each package of 100 forms is $15.00
plus shipping & handling (see below). All charges must be prepaid and returned with this form. Send check or money order made
payable to the District Court of Maryland. DO NOT SEND CASH. No C.O.D. Orders will be accepted. There is a $10.00 service
charge for all returned checks.
SUBMIT FOUR PARTS TO: District Court of Maryland, Attn: Forms Order Clerk, Traffic Processing Center, 2020 Industrial
Drive, Annapolis, Maryland, 21401. Retain goldenrod copy for your records.
*Forms may also be picked up at the District Court Warehouse, located at 2002A Industrial Drive, Annapolis, Maryland, 21401, (at the rear of the
Annapolis Commerce Park complex), Monday through Friday, between 8:30 a.m. and 4:00 p.m. Call first for availability of form(s) and/or
directions to the District Court Warehouse, Phone: 410-260-1660. Payment for cost of forms (no S & H) is required upon pick-up, only checks or
money orders will be accepted.
DCA-040A (Rev. 12/2021)
FORM # # of PACKAGES FORM # # of PACKAGES FORM # # of PACKAGES
Subtotal #
of Packages
Subtotal #
of Packages
Subtotal #
of Packages
TOTAL # OF PACKAGES REQUESTED
Use this fi
g
ure when calculatin
g
shi
pp
in
g
& handlin
g
char
g
es (see below)
(Total # of packages x $15.00)
COST OF FORMS $
Shipping & Handling
Charge: $4.00 for the first package of forms
$ .75 for each additional package
Forms will be shipped U.P.S. to the above "Ship to" address*.
SHIPPING & HANDLING $
Enclose check or money order made payable to the DISTRICT COURT OF MARYLAND.
DO NOT SEND CASH. No C.O.D. orders. There will be a $10.00 service charge for all
returned checks.
TOTAL $
(Please use complete street address. UPS cannot deliver to P.O. Box addresses.)
Reset
