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.