68 Dale Smith.pdf
PDF 117 KB Posted
- Attached to
- Release State Use/Facilities for Persons with Severe Disabilities IL|25-416CMS-BOSS4-P-75951
- Contract number
- 25-416CMS-BOSS4-P-75951
- Issued by
- Illinois
About this file
Business Card Request Form Submission
This is a Business Card Request Form completed by Dale Smith on November 4, 2025, submitted to the State of Illinois. The respondent is an employee of the Arson Division working in the state government structure. The form serves as an internal order request for business card printing or reordering services through a state procurement process.
Dale Smith, Youth Firesetting Intervention Coordinator, submitted a reorder request with no changes to existing business card specifications. The order requests 500 business cards to be delivered to Springfield. Contact information on file includes office number 217-785-4713, cell number 217-720-5835, email dale.smith2@illinois.gov, and office address 1035 Stevenson Drive. The form included submission of a current business card image (Business Card_Dale Smith.JPG) and provided space for any requested modifications, which remained blank in this submission. The list of changes, notes, or additions field was left empty, confirming the reorder reflects no updates to the previous card design or content.
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Other files
| File | Type | Posted |
|---|---|---|
| 67 John Andersen.pdf | ||
| 68 Business Card_Dale Smith.jpg | JPG image |
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Dale Smith 07:58 Time to complete
Respondent
Re-order with NO CHANGES
Re-Order, SEE CHANGES BELOW
New Order
Order Request * 1.
Business Card_Dale Smith.JPG
Please attach a picture of your current business card with this order. Please mark any changes on the business card or make notes below.
2.
11/4/25, 3:36 PM Business Card Request Form https://forms.office.com/Pages/DesignPageV2.aspx?origin=NeoPortalPage&subpage=design&id=nwgia7qOPEaE9TFxIQ-QBYd4wejjQSBNhNZZyWb… 1/3 https://ilgov-my.sharepoint.com/personal/clint_everetts_illinois_gov/Documents/Apps/Microsoft%20Forms/Business%20Card%20Request%20Form/Question/Business%20Card_Dale%20Smith.JPG
Arson
Boilers
Elevators
Executive
Fire Prevention
Fire Service Outreach
Fiscal
Information Technology
Internal Audit
Legal
Management Services
Personnel Standards & Education
Petroleum & Chemical Safety
Special Projects
Technical Services
Division * 3.
Name (as appears on card) * 4.
Dale Smith
Title * 5.
Youth Firesetting Intervention Coordinator
Address * 6.
1035 Stevenson Dr.
Office Number * 7.
217-785-4713
Cell Number * 8.
217-720-5835
Fax Numer * 9.
000-000-0000
11/4/25, 3:36 PM Business Card Request Form https://forms.office.com/Pages/DesignPageV2.aspx?origin=NeoPortalPage&subpage=design&id=nwgia7qOPEaE9TFxIQ-QBYd4wejjQSBNhNZZyWb… 2/3
Email * 10.
dale.smith2@illinois.gov
List of changes, notes, or additions11.
Quantity * 12.
Springfield
Chicago
Deliver to * 13.
11/4/25, 3:36 PM Business Card Request Form https://forms.office.com/Pages/DesignPageV2.aspx?origin=NeoPortalPage&subpage=design&id=nwgia7qOPEaE9TFxIQ-QBYd4wejjQSBNhNZZyWb… 3/3
File details come from the government source that posted it. Updated .