We welcome orders from military, government agencies and educational institutes. Please print out this page, complete and fax it back to 561-997-6082 Attn: Sales Dept. to complete your order.

In order to ship your order, the followings are required.
Valid Purchase Order Form on School, Government Agency Letterhead
Complete Billing Information
Complete Shipping Information
Contact Person's Name and Phone Number
Authorized Signature and Position of Signer

You can use your own government or educational institute purchase order form.

Government | Military | School Orders

Shipping Information
Purchase Order Number: Tax ID Number (if any):
Name of Agency/Institute: Division/Department:
Name of Contact: Position:
Phone Number: Fax Number:
Email Address:   
Shipping Address:
Payment Information
Option 1:
Payment Terms Desired: 15 Days or 30 Days

Option 2:
Credit Card Number:

Card Expiration Date:
Billing Address:
Product Name and Description: Cartridge No.: Unit Price: Quantity:

Additional Instructions:

Order Authorized By:

Please Print Your Name: __________________________________

Authorized Signature: ____________________________________

Office Use Only: Received By:
Approval By: Approval Date: