Order Form     

    All Fields required unless otherwise stated

 Name:         

 Printer Model:
 Company:      (not required)

 Address:      
 City:         
 State:        
 Zip/Postal:   
 Country       
     
 Telephone:  
 Fax:        (not required)
 E-mail:     


  Visa   Mastercard    American Express    Discover  

 Name on card: 
 Card Number:  
 Expiry date
 Month(eg. 08):Year(eg. 97):

 When ordering below, please use the kit # (eg. eps89 or hp26a)
 for refill kits, and if ordering cartridges, the cartridge
 number (eg. S020089)

 Cartridge#       Quant.  Cost Per Unit    








 A $3.50 Shipping and Handling will be added to every order.