Precision Cartridge, Inc.
940 Georgiana St.
Hobart, IN 46342

Phone: 219-942-2400
Fax: 219-947-3405

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We are now accepting Mastercard and Visa when order is faxed or placed by phone. Please 
Print this page, fill in the details and fax it to our office 24 hours a day 7 days a week. 
If you do not have access to a fax machine: phone your order to 219-942-2400. 

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Exact Name of Card Holder:	____________________________________ 

Address of Card Holder:		____________________________________ 

                         	____________________________________ 

City:				____________________________________  

State and Zip Code:		____________________________________  

Phone Number:             	____________________________________   

Date:				____________________________________ 

E-Mail Address:           	____________________________________ 

Credit Card:              	Mastercard [ ]      Visa  [ ]             

Card Number:              	____________________________________ 

CIV Number:              	_________

(The CIV number is the 3-digit number located on the back of your card, 
usually at the top of the signature strip.)

Card Expiration Date:     	____________________________________ 

Signature of Card Holder:	____________________________________ 

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