I do not understand ? is this form only intended for printing? if yes, then it is ok.
Also, if it NOT to be submited but only printed, why did you use form fields instead of simple rectangles ?
As last remark: i prefer, when i need to have a document printed, to create a Word or PDF file that the user can download, fill in and fax me. HAve a look at this form and try it: after you fill in all the details, it creates a word document that can be downloaded:
http://www.dbtechnosystems.com/montg...test_form.html