Print this form and send it to the address below with your check or money 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 8/22/01

Price Info  Quantity Price Sub-Total
Fewer than 15 brooms - enter $35.00 per broom    $35 ea  
Add $9 Shipping/Handling for the first broom   $9  
Add $5 Shipping/Handling for each additional broom   $5  
For a case of 15 brooms without handles ($30/broom)   $450 ea  
Add $29 Shipping/Handling for each case   $29  
For 15 high-quality broom handles add $120 (shipping included)    $120 ea  
ADD YOUR TOTALS HERE

TOTAL

 

For larger amounts we offer additional discounts. 
E-mail us at
[email protected] or call us at  866-926-9969 (toll free)
National Sales Representative:  702-596-2933
Send check, or money order to Dieselboss, Inc. 1308 Tamarack Court SW, Albany OR. 97321
Click here for our return policy.