SUPPLIES ORDER FORM
Dear Customer:
Please send this order, along with proper payment, to the address below, OR, Visa, MasterCard or Discover
holders, call toll free, 1-800-284-4357, or fax your completed order form to 1-800-947-1445
Stock No.
Description
Price
Quantity
Total
Subtotal
Name:
Accessory Subtotal:
$
Address:
AZ, CA, CT, GA, IL, LA, MA, MI, MN,
City:
MO, NC, NJ, NV, NY, TN, TX, VA, WA,
State/Zip:
residents add applicable sales tax
$
Daytime Phone:
Shipping/Handling Options
Please choose one:
•
Standard ($5.00)
SEND ORDER FORM TO:
•
2nd day air freight ($8.75)
Brother International Corp.
Mandatory for all deliveries
Attn: Consumer Accessory Div.
outside of the continental U.S.
P.O. Box 341332
(Alaska, Hawaii, Puerto Rico,
Bartlett, TN38184-1332
Virgin Islands & Canada)
•
All other overseas orders ($25.00) $
TOTAL DUE
$
Method of payment (Check one)
( ) Visa ( ) MasterCard ( ) Check/Money Order
Account Number
Expiration Date
Signature
* Prices subject to change without notice.
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