Fax Order Form
Phone: 800-963-7367
International: 732-583-4786
Fax: 732-583-6644
Credit Card Billing Address Shipping Address
Name: Name:
Organization: Organization:
Address 1: Address 1:
Address 2: Address 2:
City: City:
State + Zip: State + Zip:
Country: Country:
Phone: Phone:
Fax: Fax:
Email: Email:
PAYMENT INFORMATION
_Visa   _Mastercard   _ AMEX _ Discover Expiration Date: __________________

Card # ________________________________

Signature__________________________
Item Number Name Qty Unit Cost Total
         
         
         
         
         
  Subtotal  
   7% NJ Sales Tax  
Shipping Method   Shipping Price  
  Total  
Shipping Option Price Starting At...
Refills Only (First Class US Mail) **Bottled Ink Excluded** $ 3.25
Economy (3-10 Business Days) $ 5.95
Standard (2-6 Business Days) $ 8.95
Expedited (2-3 Business Days) $ 24.95
UPS Next Business Day Express $ 44.95
UPS Next-Day Saturday Delivery $ 59.95
Canada: (via Parcel Post - No Tracking) $ 14.95
Canada: (via Priority Mail - Delivery Confirmation) $ 29.95
Canada: (via EMS Service) $ 44.95
USPS First Class International (No Tracking Number) $ 24.95
USPS Priority International (with Tracking Number) $ 44.95
International: US Postal EMS Service $ 59.95