Fill in this form to receive a detailed overview on how much your cartridges are worth.
	Company name:
	Contact person:
	Address:
	Place:
	Country:
	Tel. no:
	Fax no:
	E-mail:
	How many cartridges do you use in 1 year: < 10 10 - 50 50 - 100 100 - 200 > 200
	Do you need a new price list? yes no
	Do you want us to pick up the cartridges? yes no
	How many cartridges can we pick up?
	Further information/remarks: