Inkjet-Cartridges-Refills Order Form
(For International and Other Orders)

After printing and filling out this form, 
please fax (503-643-5379) or mail it to us:
Inkjet-Cartridges-Refills
10200 SW Eastridge Street, Suite #105
Portland, OR  97225

Office use only:

Date Received_____________
Order Number _____________
Initials __________
Name (First and Last): Company:
Shipping Address: City:
State/Province: Postal Code: Country:
Phone # (with country/area codes, if appl.): Fax #:
Email address:

ICR Part # Description Quantity Price per Item Total Cost
         
         
         
         
         
         
         

    Choose a Shipping Method: UPS or USPS* (circle one)
Shipping Charge for Method Chosen:

  

Handling ($5.00 fee added to all international orders):

  

Order Total:

  
*I understand that Inkjet-Cartridges-Refills will not be held liable for lost or stolen packages shipped via USPS Priority Mail, and that ICR will not be responsible for additional fees.
 
Credit Card #: Exp.: _____ Mo _____ Yr CVV #*:
Billing Address: City:
State/Province: Postal Code: Country:
Phone # (with country/area codes, if appl.): PO # (if appl.):

*The CVV # can be found on the back of your card, above the signature area.

                        I am the authorized account holder of the credit card listed above. 

I have read, understood, and agreed to be bound by the Terms and Condition of Sale
at https://www.epson-inkjet-cartridges-refills.com/terms.htm (link) and the Return Policy
currently in effect at https://www.epson-inkjet-cartridges-refills.com/returns.htm (link).

Signed: ______________________________  Date: _______________________