Print this form and send it
to the address below with your check or money order.
If you do not have a printer, please
write down the below information and include with your order.
ReferSweeper™ Order Form
Company Information
Company Name ____________________________________________________
Company Address __________________________________________________
Company City ______________ Company State ________Zip Code ___________
Purchase Order Number________________Business E-Mail ________________
Fax
Number
__________________
Phone Number
__________________
Web Page Address __________________
Individual Information
Your Name
________________________Position____________________
Contact Number ___________________
Your E-Mail Address ________________________Fax Number_________________
Shipping Information. If it is the same as above write SAME below.
Name
___________________________________________________________
Address ___________________________________________________________
City ___________________________________________________________
State _______ Zip Code__________
Please use the
following pricing chart to calculate your order:
Pricing effective as of 03/29/07 - NO SALES TAX
- Canadian Customers PLEASE PHONE IN YOUR ORDER
| Price Info (US Orders only) | Qty | Price | *Shipping | Sub-Total |
| One 24" ReeferSweeper Trailer Broom (Handle Included) |
$29.95 ea | $11.00 per broom | ||
| One case of 12 Trailer Brooms (without handles) |
$264.00 | $24.00 per case | ||
| One case of 12 Retractable Handles | $60.00 | $15 per case | ||
| One 5x5 Mini-case (contains 5 brooms and 5 handles) | $125 | $25 per case | ||
| ADD YOUR TOTALS HERE |
TOTAL |
|||
For larger amounts we offer additional discounts.
E-mail us at
[email protected]
or call us at 866-851-2346
(direct # is 503-336-4228)
Send check, or money order to Dieselboss, Inc. 1308 Tamarack Court SW, Albany
OR. 97321