10200 SW Eastridge St, Ste 105
Portland, Oregon  97225
Phone: 503 972 0360
Fax: 503 643 5379

Order Form (Fax or Mail Order)

After filling out this form
     Please fax it to 503 643 5379 or mail it to us at:

     10200 SW Eastridge St, Ste 105

     Portland, OR  97225   (USA)

For Office Use Only                                  
     Order #:
     Date received:
     By whom:
Name:
Company:
Shipping Address:
     [   ]  Return for exchange
     [   ]  Return for refund
     [   ]  Return for in-store credit
     [   ]  Return for repair/replacement
     [   ]  Advanced replacement/return

Contact Name:
     Email:
     Telephone:
     Fax:
  Part Number Qty Price per Item Subtotal

Line 1

        
Description:

Line 2

        
Description:

Line 3

        
Description:

Line 4

        
Description:

Subtotal:

  

Shipping (UPS or USPS):

  

Handling ($5.00 for all international orders):

  

Order Total:

  

 

Cardholder Name:
Billing Address:

 

 

Credit Card#:
Expiration Date:
CVV # (found on the back of credit card):

Purchase Order # (if applicable):

I am the authorized account holder of the credit card listed above.

I have read, understood and agree to be bound by the Terms and Conditions of Sale (see http://www.inksforless.com/terms.htm [link]) and the Return Policy currently in effect (see http://www.inksforless.com/returns.htm [link]).

Your order form must be signed and faxed to (503) 643-5379 or mailed to the address above and we will process it. A response will be emailed to you. It is the responsibility of the customer to ensure receipt of this form by InksForLess.com.

Signed:_________________________________________________   Date:_______________________