WWW.LASERPRINTERKITS.COM
Setup account: Richard Lord
www.laserprinterkits.com
823 Oakmoor Dr
Fenton, MO 63026
ricklord@charter.net
phone:  636-861-2321
fax: 866-618-3981
Order Date:    
Order Number:    
Purchase Order:    
Purchase Order
Ship To
Name
 
Company  
Address  
City, State, Zip  
Phone  
Bill To
Name  
Company  
Address  
City, State, Zip  
Phone  
Description Qty Unit Price Total
       
       
       
       
       
       
Order Total  
Shipping (See table below for rates)  
SHIPPING RATES: TOTAL AMOUNT  
Under 25 USD = 4.95
25.01 - 50.00 USD = 6.95
50.01 - 100.00 USD = 8.50
100.01 - 150.00 USD = 13.00
150.01 USD and above = FREE SHIPPING
Terms: Net 30 days  
  Payment type (Circle)   CHECK MONEY ORDER
Credit Card Payment (Circle type):  MC/Visa/Discover By Quickbooks:  
Name on Card:
Card Number:
Expiration mo/yr:
Any reference you would like added to the credit card information for your billing purposes:
Please fax this information via the toll free fax number 866-618-3981 to laserprinterkits.com.   
We will send you an e-mail confirming the order and process the order.  Your statement 
will show laserprinterkits as a charge to your card for payments made to Laserprinterkits.com.
Thank you for your business!