Fax/Mail Prepaid Mailer Request Form

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For Printer Model	Cartridge type	Refills(2or4)	Qty	Price

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Mail your request to:

Performix LLC
4905 W. 84th Street
Bloomington, MN 55437 USA
Fax: 413 502-9312
Tel: 952 893-0143 (Twin Cities, Minnesota region)
Toll free: 1-877-453-3640

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