ࡱ> ;E:p%` GbjbjNN ?X,,vxxxxxxx8\(mdbmH((((@(lRFlc$eh7hcExcxx'd!!!dxx(!(!!#hxx4$ 0, X$%=d0md$$ht h 4$4$hxH$Xq!lcUcch!Xmd0d0xxxxxx  REQUEST FOR MICR TONER Please fill out all information and fax to the WIC NSB HELPDESK at (919) 870-4863. WIC PROGRAM NUMBER: FORMTEXT      WIC SITE NUMBER FORMTEXT      WIC PROGRAM NAME: FORMTEXT      STREET ADDRESS:  FORMTEXT      City, State, Zip: FORMTEXT      NC FORMTEXT      If the location is not open Monday  Friday for deliveries, please list the main site. PHONE NUMBER: (  FORMTEXT     ) FORMTEXT       FORMTEXT FAX NUMBER: (  FORMTEXT     )  FORMTEXT       TYPE OF TONER NEEDED: (Please  CHECK printer type) FORMCHECKBOX  ST-9530 N FORMCHECKBOX  ST-9325 NNUMBER OF CARTRIDGES NEEDED: FORMTEXT      Please keep in mind that toner arrival will require a ten day grace period after order is placed. Check for correct toner cartridge and use old toner first. Toner packing slip must be signed by WIC Staff only. 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