Milner Document Products, Inc.

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ORDER TONER AND SUPPLIES

Thank you for choosing Milner! Please fill out the form below to order supplies on-line. You must include your name, phone number, model and serial number, and the items you need to order. Orders received before 2:30pm EST will be processed the same day. Shipments will be made according to your selection below.

You can also call us toll free at (877) 264-5637 or locally at (770) 734-5325 to place your order.

In addition to Lanier, Ricoh, Nefax, and Minolta, we can also provide supplies for most brands of office equipment (laser printers, copiers, facsimiles, etc.).

We look forward to assisting you with your supply needs!

SUPPLY ORDER FORM

CUSTOMER INFORMATION

* Your Name:
* Company:
Address 1:
Address 2:
City:	State: Zip:
* Phone #:
* E-mail:
* Model #:	* Serial #:
B&W Meter Reading:
Color Meter Reading:

ORDER

Check here if you wish to receive a duplicate of your last order, otherwise fill out the quantities and items you wish to order below.

QUANTITY	ITEM DESCRIPTION

DELIVERY OPTIONS

**Please note that our warehouse is located in Atlanta, GA. Same day courier service is only available to customers in the Atlanta metro area. All other customers must choose Standard Delivery or Next Day Delivery. Next Day Delivery orders must be received before 2:30pm EST in order to process the same day.**

Standard Delivery	Same Day Courier (Emergency Service)
Next Day Delivery	Hold for Pickup

OTHER INFORMATION

Comments:
PO #:

* Denotes Required Field