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The Refill Connection Deluxe Wirebound Refills Order Form

Welcome to The Refill Connection's Deluxe 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 Ivory Subtotal
Wire Bound Refills [ 2 5/8" x 4 1/4"] Deluxe
PD42W18 Wirebound Planning Diary 2018 $9.00 Each
PD42W17 Wirebound Planning Diary 2017 $9.00 Each
240MP Slip in Note Pads $6.00 Each

Item Number Item Description Price Quantity Ivory Subtotal
Wirebound Refills [3 1/4" x 6 1/4"] Deluxe
PD61W18 Wirebound Diary 2018 $11.50 Each
PD61W17 Wirebound Diary 2017 $11.50 Each
PAD63 Writing Pad (3) $3.75
AD61W Wirebound Address Book with Mylar Tabs $14.00 Each

Item Number Item Description Price Quantity Ivory Subtotal
Wirebound [ 8" x 5" ] Deluxe
PD85W18 Wirebound Planning Diary- Weekly view 2018 $16.25 Each
PD85W17 Wirebound Planning Diary- Weekly view 2017 $16.25 Each

Item Number Item Description Price Quantity Ivory Subtotal
PD18WI18 Wirebound Planning Diary- Weekly view 2018 $27.00 Each
PD18WI17 Wirebound Planning Diary- Weekly view 2017 $27.00 Each
PAD18 8.5 x 11 Writing Pad (5) $7.50
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.