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.
Name:
Address:
City:
State/Zip:
Daytime Phone:
SEND ORDER FORM TO:
Brother International Corp.
Attn: Consumer Accessory Div.
P.O. Box 341332
Bartlett, TN38184-1332
"
Description
Method of payment (Check one)
( ) Visa ( ) MasterCard ( ) Check/Money Order
Account Number
Expiration Date
Signature
Accessory Subtotal:
AZ, CA, CT, GA, IL, LA, MA, MI, MN,
MO, NC, NJ, NV, NY, TN, TX, VA, WA,
residents add applicable sales tax
Shipping/Handling Options
Please choose one:
• Standard ($5.00)
• 2nd day air freight ($8.75)
Mandatory for all deliveries
outside of the continental U.S.
(Alaska, Hawaii, Puerto Rico,
Virgin Islands & Canada)
• All other overseas orders ($25.00)
TOTAL DUE
* Prices subject to change without notice.
Price
Quantity
Subtotal
Total
$
$
$
$