Name: ______________________________________
Street Address: _______________________________
Apt/Unit #: __________________________________
City: _______________________________________
Prov/State: __________________________________
Country: ____________________________________
Postal/Zip Code: ______________________________
Phone Number: _______________________________ *Important*
Fax Number: _________________________________
E-Mail: _____________________________________*Important*
Kit/Cartridge number: ____________________
Quantity: ________________________
Description: _________________________________
Price: $___________
If you need more space, please write in the open space to the above right.
Shipping method, please check:
_____ U.S.A. - $4.50
_____ Canada - $9.50
______International - Air Mail $19.50
Total Invoice: $____________________
Please Make the Check or Money Order payable to:
The Printer Filling Station
1403 Shiloh Oak Drive
Loganville, Georgia 30052
USA