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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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