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Please print, fill out, and mail in this order form with your personal check, money order or cashier's check. You may call 1-800-887-1882, to place a credit card order over the phone. Sorry, C.O.D's are not accepted.


Mr. Ink Jet, Inc. Mail-In Order Form

Customer Information (Shipping/Billing):

First & Last Name: ________________________________________

Street Address:      ________________________________________

City:__________________ State:_____________ Zip: ____________

Phone: (     )_______-________  Alt Phone: (     )_______-_________

Email Address: ___________________________________________

Product Information: (please indicate printer brand name, model number and cartridge number)

example: Epson Stylus Color 980 - Black refill kit for T003011 and Color kit for T005011 ink cartridges






Subtotal: ___________

Shipping: $3.85 UPS Ground (free after $50.00) ____
                    $3.85 USPS Priority Mail (free after $50.00) ____

                    $3.00 First Class Mail ____
                    $12.00 Air Mail Canada _____
                    Other international shipping call for quote

Subtotal: _________
Texas residents add 8.25% Sales Tax ______

Total: ___________

____ check enclosed

____ charge my credit card

           ___American Express ____Discover  ____MasterCard   ____Visa

           Credit Card Number:_____________________________________

            Expiration Date: _________

            Name as it appears on card:______________________________

            Customer Signature: ___________________________________