Discount Printer Ink Cartridges .com -- Order Cancellation Request

10200 SW Eastridge St, Ste #105, Portland, OR 97225 - phone +1 503 972 0360 - fax +1 503 643 5379 - support@discountprinterinkcartridges.com

Request Type (please check one):
     [   ] Cancel and issue refund
     [   ] Cancel and issue in-store credit
     [   ] Change order*

*If you choose this option, please fill out the supplementary order form available at http://www.discountprinterinkcartridges.com/order_form.htm.

For Office Use Only
     Date Received:
     Date Cancelled:
     By whom:

Name:
Shipping Address:
     [   ] Return for exchange
     [   ] Return for refund
     [   ] Return for in-store credit
     [   ] Return for repair/replacement
     [   ] Advanced replacement/return

Order Number:
Contact Name:
     Email:
     Telephone:
     Fax:

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I understand that I am responsible for any charges incurred by Discount Printer Ink Cartridges .com for packages that have shipped prior to receipt of this Cancellation Request.

I understand that this Order Cancellation Request will be processed according to the Terms and Conditions of Sale currently in effect. I have read, understood and agree to be bound by the Terms and Conditions of Sale (see http://www.discountprinterinkcartridges.com/terms.htm [link]) and the Return Policy currently in effect (see http://www.discountprinterinkcartridges.com/return_policy.htm [link]).

Your request must be signed and faxed to +1 503 643 5379 or mailed to the address above and we will process it. A response will be emailed to you. It is the responsibility of the customer to ensure receipt of this form by Discount Printer Ink Cartridges .com.

Signed:_________________________________________________ Date:_______________________