Fax/Mail Order Form

Phone: 952-893-0143

Fax/Mail Order Form

    • Please print this form and fill your request.
   Name:
Address:
   City:
  State:    Zip:
Country:
  Email: 
  Phone:

 

Fill your order below:
For Printer Model Cartridge type Qty Price
 
 
 
 
MINNESOTA Residents add 7.25% sales tax:
Shipping charge is $4.99 for all orders below $75:
Priority mail charges are $6.99.
TOTAL:

Payment Type:    Check    Credit Card

Credit card Information:
 
Credit card type:
 Credit card #:
Name on the card: Expiry date:
(3 or 4 digit code from back or front of card) CCV:

Mail your order to: 

     
Performix LLC
7401 Coventry way Minneapolis, Minnesota 55439 USA		 Fax: 952 400-8008  


Email : [email protected]
Tel: 952 893-0143 (Twin Cities, Minnesota region)

Please enter any other additional request/suggestion: