MaxPatch Ink Supplies Print Out Order Form

Print this Form and Fill it out.... assuming you have ink. :-)
If not, just fill out a blank sheet of paper and use the form as a guide.
Questions, problems? Call toll-free 1-888-231-3426 9a-5p Pacific Time

Please Send Check or Money Order Along With Order Form to:		MaxPatch Services 7600 Pah Rah Dr *Sparks, NV 89436-9097*
Or You Can Fax It With Your Credit Card Info To:		815-550-5440

-- Qty--	--Item Number--	-------------------Description --------------------	----Each----	---Total---









Merchandise Total U.S. Funds
Nevada Residents Add 7.375% Sales Tax
(Free Shipping on orders $50 and up) - Shipping				4.60
Total Amount U.S. Funds

--Billing Info: Your Name & Address Here

Name:

Address: |Apt.|

City: |State| |Zip.|

E-Mail: Phone Number

Payment (please check):

____Check ____Money Order
____Visa ____Mastercard
____American Express ____Discover

**Card Number**
				-					-					-

**Expiration**
		---

Signature____________________________________________

--Ship To: Name & Address Here ( If Different From Billing Info)

Name:
Address: \|city\| \|state\| \|zip\|

Any questions, please feel to email us ink@maxpatch.com Thank You for shopping with MaxPatch Ink Supplies.