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