Please print this Order Form and mail it to us


   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. -  $6.50
   _____ 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