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The Refill Connection Standard Wirebound Refills Order Form

Welcome to The Refill Connection's Standard Wirebound Products order page. This page has been designed to be filled out, printed and then faxed to us toll-free with your complete order information. Follow the simple instructions below to order your replacement time management system today.

Please follow these instructions.
  1. Fill out all ordering information.
  2. Select your refill products.
  3. Print out the completed form.
  4. Fax the form toll-free to our Boston location for immediate service.
  5. Fax toll-free to: 877 733-4551
  6. For more information phone toll-free 866 733-4559
  7. How to find the right size insert


The following items are all required to complete your order.
Name: please enter your name as it appears on your credit card
Email Address: please enter your email address
Phone Number: please enter your phone number with area code
Billing Address: please enter your Billing Address
Ship-to Address: please enter your ship-to address if different from Billing Address.
Credit Card Number please enter your card number
Expiration Date: please enter your credit card's expiration date- MM/YY
Credit Card Type: Please select card type MC Visa Amex
Item Number Item Description Price Quantity
White only 		Subtotal
PDR42W12 Wirebound Planning Diary 2012 $7.75 Each
PDR42W11 Wirebound Planning Diary 2013 $7.75 Each
ADR42W Wirebound Address Book $10.50 Each
PAD42 Slip in Memo Pads ( per 5) $6.00 pack of 5
Item Number Item Description Price Quantity
White only 		Subtotal
Wirebound Refills [ 3 1/8" x 5"]
PDR536W12 Wirebound Planning Diary 2012 $13.00 Each
PDR536W11 Wirebound Planning Diary 2013 $13.00 Each
ADR536W Wirebound Address Book $6.50 Each
PAD536 Note Pads (3) $3.00
Item Number Item Description Price Quantity
White only 		Subtotal
Wirebound Refills [3 1/4" x 6 1/4"]
PDR63W12 Wirebound Planning Diary 2012 $9.50 Each
PDR63W11 Wirebound Planning Diary 2013 $9.50 Each
ADR63W Wirebound Address Book- Standard $9.50
PAD63 Pack of 3 slip-in Memo Pads $3.75 Pack of 3
MIT63 Monthly stick-on Index Tabs $5.00 Per Pack
Item Number Item Description Price Quantity
White only 		Subtotal
PDR85W12 Wirebound Planning Diary 2012 $13.00 Each
PDR85W11 Wirebound Planning Diary 2013 $13.00
ADR85W Wirebound Address Book $12.50 Each
PAD85 Slip-in Memo Pads per 5 pads $8.50 per pack
MIT85 Monthly Sick-on Index Tabs $6.00 per pack
Shipping Charges
For Domestic Standard Shipping Add $5.00 to order
For Domestic UPS Blue Label Shipping Add $12.00 to order
All Foreign Orders Add $15.00 to order
Subtotal with Shipping
Massachusetts Sales Tax
Massachusetts residents please add 5% sales tax
Total Order

Please make sure that:
  • You have filled in the account information at the top of this form.
  • You have checked your order quantities and styles.