ACSI Bulk Inks
7190 State Route #60
Clarksburg, WV 26302
United States of America
(You may print out
this form by clicking
on the printer symbol in your browser.)
All prices are in United States Dollars.
Telephone: +1-304-622-5086 or 1-888-728-2465
|List of WJxxx ink numbers you need or your specific printer model:
Printer or Cartridge Model Number:______
|Quantity of ink you need:
|Price for the ink:
Empty Syringe Bottle pricing is:
Number of syringe bottles you need:|
|Additional Accessories Needed (Specify):
Shipping and HandlingMost of USA:
Check the number of pints in your order to determine the shipping charge.
USA Outlying Regions: For shipping to AK, HI, PR, VI, MP, GU, APO/FPO use this chart.
Domestic USA only - COD orders are also accepted. There is a $7.50 COD fee. COD orders must be paid by cashiers check, certified check, or money order -- no personal or business checks accepted.
|If COD, add to your order total: |
Enter any comments here:
|Check your total.||Your order total is: ||$_______
(9999 9999 9999 9999):
_____ _____ _____ _____
|Exact Name on the card|
(John E Smith):
|Billing address for your card if different from shipping address:
Please sign here for credit card orders