Ink-Cartridges-Canada (Kurn Computers) Order Form	Fax To: (519)652-8572
(Please Print)

Name:__________________________________________ Company Name:____________________________ Street Address:____________________________ City:______________________________________ Province:__________________________________ Postal Code:_______________________________ Country:___________________________________ Telephone Number:__________________________ Fax Number:________________________________ E-mail Address:____________________________ Credit Card Info VisaMastercard Name on Card:__________________________________________ Account Number:__________________________________ Expiry Date:_______________________ Shipping is calculated on purchase amount before taxes: $00.01-$39.99 = $10.00. $40.00-$99.99 = $7.00. $100.00 and over = FREE Quantity OEM Number Printer Model Price ___________________________________________Plus Shipping $_________ Signature:___________________________________ Date:___________________________________