Dear Customer:
This order form is provided for your convenience should your retailer not stock the item(s) needed. To order by mail, send this completed form along with proper payment to the address below OR credit card holders: call
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To complete the Order Form:
1.Review the reverse side of this form and select the desired items.
2.Complete the form above, indicating the quantity of each item.
3.Total the columns and enter the total on the “Supply/Accessory Subtotal” line.
4.Add the appropriate Sales Tax and Shipping/ Handling Charge.
5.Clearly print your name and address in the space below.
6.Place your order
a.Call toll free anytime
b.Order on line at www.brothermall.com
c.Fax completed form to
d.Mail completed form along with proper payment to
BROTHER INTERNATIONAL CORP. Attn: Consumer Accessory Div. P.O.Box 341332
Bartlett, TN
Name:
Address:
City:
State:
Zip:
Daytime Phone #:
Daytime Fax #:
Email:
Your Model Number:
Supply / Accessory Subtotal: | $ |
AZ, CA, CO, CT, FL, GA, IL, LA, MA, MD,MI, MN, MO, NC, NJ, NV, NY, OH, PA, TN, TX, VA, WA residents add applicable sales tax: $
Shipping and Handling Options | $ |
Please choose one: |
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•Standard Freight: |
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•Continental U.S. ($5.75) |
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Alaska and Hawaii ($8.75) |
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GU, PR, VI ($15.75) |
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•2nd Day Air Freight |
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(Continental U.S. only): $8.75 |
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•Overnight Delivery |
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(Continental U.S. only): $14.75 |
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TOTAL DUE | $ |
No C.O.D. orders |
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Method of Payment (check one)
( ) Visa ( ) Master Card ( ) Discover
( ) Check/Money Order ( ) American Express
Account Number
Expiration Date
Signature
Billing Address (if different from shipping address at left)
Prices subject to change without notice.All prices quoted in US Dollars.