2
SUPPLY KITS CD/DVD MEDIA e c i r P e c i r P t i n U n o i t p i r c s e D t c u d o r P r e b m u N t r a P y t i t n a u Q Subtotal Subtotal of all sections Sales Tax Total PER9146 PER9133 PER9134 PER9135 High yield CYAN (C) ink cartridge (1) for Discproducer, prints approximately 1000 discs High yield LIGHT MAGENTA (LM) ink cartridge (1) for Discproducer, prints approximately 1000 discs High yield MAGENTA (M) ink cartridge (1) for Discproducer, prints approximately 1000 discs High yield LT CYAN (LC) ink cartridge (1) for Discproducer, prints approximately 1000 discs PER9138 High yield BLACK (K) ink cartridge (1) for Discproducer, prints approximately 1000 discs PER9136 Media Writer D200 / D100 Replacement ink cartridge – Black Media Writer D200 / D100 Replacement ink cartridge – Cyan 1000 Perceptive water repellent CDs, Discproducer ink cartridges (6) Media Writer D200 / D100 Replacement ink cartridge – Lt Cyan Media Writer D200 / D100 Perceptive CD Supply Kit PER9145 1000 Perceptive Premier CDs, Discproducer ink cartridges (6) Media Writer D200 / D100 Perceptive Premier CD Supply Kit Media Writer D200 / D100 Replacement ink cartridge – Magenta Media Writer D200 / D100 Replacement ink cartridge – Lt Magenta PER9137 PER9127 PER9126 High yield YELLOW (Y) ink cartridge (1) for Discproducer, prints approximately 1000 discs Media Writer D200 / D100 Replacement ink cartridge – Yellow CD-R Media, 50 discs, 700MB, 52x, glossy white, water resistant surface CD-R Media, 50 discs, 700MB, 52x, non-glossy white, water repellent surface Perceptive CDs (50) Perceptive Premier CDs (50) Perceptive Premier DVDs (50) PER9132 Media Writer D200 / D100 Replacement color ink cartridges High yield color ink cartridges (6) for Discproducer, prints approximately 1000 discs Perceptive Media Writer D200 / Perceptive Media Writer D100 INK CARTRIDGES Supply Order Form Perceptive Media Writer D200, D100, D35 Perceptive MDR Video Billing Address is Same as Shipping Address Billing Address: Shipping Address: Facility: _____________________________________________ Address: _____________________________________________ Address 2: _____________________________________________ Address 3: _____________________________________________ City: __________________________ State: ____________ Zip Code: __________________ Country: _________________ Phone: _____________________________________________ Facility: _____________________________________________ Address: _____________________________________________ Address 2: _____________________________________________ Address 3: _____________________________________________ City: __________________________ State: ____________ Zip Code: __________________ Country: _________________ 4309 Hacienda Drive, Suite 500 Pleasanton, California 94588 USA Use Credit Card Info Payment Information (select one, required): PO Attached Perceptive Media Writer Supply Order Form Perceptive Software For questions, please contact Perceptive Software at [email protected] Fax completed form to +1 913 495 8825 Contact Name: ______________________________________________________ Contact Email: ______________________________________________________ Contact Phone: ______________________________________________________ Credit Card Type: ______________________________________________________ Credit Card #: ______________________________________________________ Expiration Date: ____________________ Security Code: ___________________ Name on Card: ______________________________________________________ Signature: ______________________________________________________ Ground shipping included with all orders PER9328 DVD-R Media, 50 discs, 4.7GB, 16x, glossy white, water resistant surface PER9332 Media Writer D200 / D100 Perceptive Premier DVD Supply Kit 1000 Perceptive Premier DVDs, Discproducer ink cartridges (6) Email (required): ___________________________________________

Supply Order Form Perceptive Media Writer D200, D100, D35 ...download.pacsgear.com/pdf/reorder.pdfPER9333 Media Writer D35 DVD 300 Perceptive Premier DVDs, one Bravo SE ink cartridge

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Page 1: Supply Order Form Perceptive Media Writer D200, D100, D35 ...download.pacsgear.com/pdf/reorder.pdfPER9333 Media Writer D35 DVD 300 Perceptive Premier DVDs, one Bravo SE ink cartridge

SUPPLY KITS

CD/DVD MEDIAecirPecirP tinUnoitpircseDtcudorPrebmuN traPytitnauQ

Subtotal

Subtotal ofall sections

Sales Tax

Total

PER9146

PER9133

PER9134

PER9135

High yield CYAN (C) ink cartridge (1) for Discproducer, prints approximately 1000 discs

High yield LIGHT MAGENTA (LM) ink cartridge (1) for Discproducer, prints approximately 1000 discs

High yield MAGENTA (M) ink cartridge (1) for Discproducer, prints approximately 1000 discs

High yield LT CYAN (LC) ink cartridge (1) for Discproducer, prints approximately 1000 discs

PER9138 High yield BLACK (K) ink cartridge (1) for Discproducer, prints approximately 1000 discs

PER9136

Media Writer D200 / D100 Replacement ink cartridge – Black

Media Writer D200 / D100 Replacement ink cartridge – Cyan

1000 Perceptive water repellent CDs, Discproducer ink cartridges (6)

Media Writer D200 / D100 Replacement ink cartridge – Lt Cyan

Media Writer D200 / D100 Perceptive CD Supply Kit

PER9145 1000 Perceptive Premier CDs, Discproducer ink cartridges (6)

Media Writer D200 / D100 Perceptive Premier CD Supply Kit

Media Writer D200 / D100 Replacement ink cartridge – Magenta

Media Writer D200 / D100 Replacement ink cartridge – Lt Magenta

PER9137

PER9127

PER9126

High yield YELLOW (Y) ink cartridge (1) for Discproducer, prints approximately 1000 discs

Media Writer D200 / D100 Replacement ink cartridge – Yellow

CD-R Media, 50 discs, 700MB, 52x, glossy white, water resistant surface

CD-R Media, 50 discs, 700MB, 52x, non-glossy white, water repellent surface Perceptive CDs (50)

Perceptive Premier CDs (50)

Perceptive Premier DVDs (50)

PER9132 Media Writer D200 / D100 Replacement color ink cartridges

High yield color ink cartridges (6) for Discproducer, prints approximately 1000 discs

Perceptive Media Writer D200 / Perceptive Media Writer D100

INK CARTRIDGES

Supply Order FormPerceptive Media Writer D200, D100, D35

Perceptive MDR Video

Billing Address is Same as Shipping Address

Billing Address:Shipping Address:

Facility: _____________________________________________

Address: _____________________________________________

Address 2: _____________________________________________

Address 3: _____________________________________________

City: __________________________ State: ____________

Zip Code: __________________ Country: _________________

Phone: _____________________________________________

Facility: _____________________________________________

Address: _____________________________________________

Address 2: _____________________________________________

Address 3: _____________________________________________

City: __________________________ State: ____________

Zip Code: __________________ Country: _________________

4309 Hacienda Drive, Suite 500Pleasanton, California 94588 USA

Use Credit Card Info

Payment Information (select one, required):

PO Attached

Perceptive Media Writer Supply Order FormPerceptive Software

For questions, please contact Perceptive Software at [email protected] completed form to +1 913 495 8825

Contact Name: ______________________________________________________

Contact Email: ______________________________________________________

Contact Phone: ______________________________________________________

Credit Card Type: ______________________________________________________

Credit Card #: ______________________________________________________

Expiration Date: ____________________ Security Code: ___________________

Name on Card: ______________________________________________________

Signature: ______________________________________________________

Ground shipping included with all orders

PER9328 DVD-R Media, 50 discs, 4.7GB, 16x, glossy white, water resistant surface

PER9332 Media Writer D200 / D100 Perceptive Premier DVD Supply Kit

1000 Perceptive Premier DVDs, Discproducer ink cartridges (6)

Email (required): ___________________________________________

Page 2: Supply Order Form Perceptive Media Writer D200, D100, D35 ...download.pacsgear.com/pdf/reorder.pdfPER9333 Media Writer D35 DVD 300 Perceptive Premier DVDs, one Bravo SE ink cartridge

INK CARTRIDGES

Perceptive Media Writer D35

CD/DVD MEDIAecirPecirP tinUnoitpircseDtcudorPrebmuN traPytitnauQ

Subtotal

PER9126

PER9143

CD-R Media, 50 discs, 700MB, 52x, glossy white, water resistant surface

300 Perceptive water repellent CDs, one Bravo SE ink cartridge

PER9127 CD-R Media, 50 discs, 700MB, 52x, non-glossy white, water repellent surface

Perceptive CDs (50)

Perceptive Premier CDs (50)

Perceptive Premier DVDs (50)

Media Writer D35 CD Perceptive Supply Kit

PER9142 300 Perceptive Premier CDs, Media Writer D35 CD Perceptive Premier CD Supply Kit

Media Writer D35 Replacement color ink cartridge

High yield color ink cartridge for Bravo SE, prints approximately 300 discs

Perceptive MDR Video

SUPPLY KITS

CD/DVD MEDIAecirPecirP tinUnoitpircseDtcudorPrebmuN traPytitnauQ

Subtotal

PER9126

PER9140

CD-R Media, 50 discs, 700MB, 52x, glossy white, water resistant surface

300 Perceptive water repellent CDs,one DUET 46 ink cartridge

PER9127 CD-R Media, 50 discs, 700MB, 52x, non-glossy white, water repellent surface

Perceptive CDs (50)

Perceptive Premier CDs (50)

Perceptive Premier DVDs (50)

MDR Video / Media Writer D30 Perceptive CD Supply Kit

PER9139 300 Perceptive Premier CDs, one DUET 46 ink cartridgeMDR Video / Media Writer D30 Perceptive Premier CD Supply Kit

PER9130 MDR Video / Media Writer D30 Replacement color ink cartridge

DUET 46 color ink cartridge for DUET 400/MDR VideoPrints approximately 300 discs

See previous page for shipping and billing information.For questions, please contact Perceptive Software at [email protected]

Fax completed form to +1 913 495 8825

W Perceptive Media riter Supply Order FormPerceptive Software

SUPPLY KITS

INK CARTRIDGES

PER9131

Supply Order FormPerceptive Media Writer D200, D100, D35

Perceptive MDR Video

PER9328 DVD-R Media, 50 discs, 4.7GB, 16x, glossy white, water resistant surface

PER9333 Media Writer D35 DVD 300 Perceptive Premier DVDs, one Bravo SE ink cartridge

PER9328 DVD-R Media, 50 discs, 4.7GB, 16x, glossy white, water resistant surface

PER9334 MDR Video / Media Writer D30 Perceptive Premier DVD Supply Kit

300 Perceptive Premier DVDs, one DUET 46 ink cartridge

Perceptive Premier DVD Supply Kit

one Bravo SE ink cartridge