Stock #; Supply / Accessory Subtotal:; To complete the Order Form:- Page 128

P-TOUCH ACCESSORY ORDER FORM

(For USA Only)

Dear Customer:
This order form is provided for your convenience should your retailer not stock the item(s)
needed. To order by mail, send this completed form along with proper payment to the address
below OR credit card holders: call toll-free 1-888-879-3232, fax completed order form to 
1-800-947-1445, or visit our web site at http://www.brothermall.com. Please refer to the
Accessories listing in your User’s Guide for stock no. and price.

Stock #

Description

Quantity

Price

To complete the Order Form:

1. Review the reverse side of this form and

select the desired items.

2. Complete the form above, indicating the

quantity of each item.

3. Total the columns and enter the total on the

“Supply/Accessory Subtotal” line.

4. Add the appropriate Sales Tax and Shipping/

Handling Charge.

5. Clearly print your name and address in the

space below.

6. Place your order

a. Call toll free anytime 1-888-879-3232
b. Order on line at www.brothermall.com
c. Fax completed form to 1-800-947-1445
d. Mail completed form along with proper

payment to
BROTHER INTERNATIONAL CORP.
Attn: Consumer Accessory Div.
P.O.Box 341332
Bartlett, TN 38184-1332

Supply / Accessory Subtotal:

$                        

AZ, CA, CO, CT, FL, GA, IL, LA,
MA, MD, MI, MN, MO, NC, NJ,
NV, NY, OH,  PA, TN, TX, VA, WA, WI
residents add applicable sales tax: 

$                        

Shipping and Handling Options

$                        

Please choose one:

•Standard Freight:
•Continental U.S. ($5.75)

Alaska and Hawaii ($8.75)
GU, PR, VI ($15.75)

•2nd Day Air Freight

(Continental U.S. only): $8.75

•Overnight Delivery

(Continental U.S. only): $14.75

TOTAL DUE

$                        

No C.O.D. orders

Method of Payment (check one)

Name:                                                                  

(  ) Visa   (  ) Master Card   (  ) Discover

Address:                                                                  

(  ) Check/Money Order   (  ) American Express

City:                                                                   
State:                                                                  

Account Number                                                      

Zip:                                                                    

Expiration Date                                                         

Daytime Phone #:                                                                  

Signature                                                                  

Daytime Fax #:                                                                  

Billing Address (if different from shipping address at left)

Email:                                                                  

Your Model Number:                                                                  

Prices subject to change without notice.All prices quoted in US Dollars.