| Quantity | Description | Unit Price | Total Cost |
| Bio-Clean 2lb Can | $43.95 | ||
| Bio-Clean 2lb Can (2 cans - save $4 each) | $39.95 | ||
| Bio-Clean 2lb Can ( 3 or more cans - save $8 each) | $35.95 | ||
| Sales Tax (Mass Residents only add 5%) | |||
| Shipping & Handling - $5 per can, (2nd day add $15) We only ship to addresses within the United States. |
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| Total | |||
| Payment | |
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Card Number ___________________ Expires ____ / _____ Seurity Code ________ (3 digits for VISA, MC. 4 digits for Amex) On the back of your Card, above the Signature after the CC number Signature __________________________ |
| Check Payable to: INFO | |
Valued Customer Name _______________________ Company ________________________ Phone # (_____)_______-_________ Fax # (_____)_______-_________ E-Mail _________________________ |
Ship to: ____________________________ ____________________________ ____________________________ Bill to: ____________________________ ____________________________ ____________________________ |
- Fax this form to SafeDrainCleaner.com at (978) 456-3848
- Mail to: SafeDrainCleaner.com, PO Box 58, Still River, MA 01467, USA
- E-mail the information to Sales@SafeDrainCleaner.com