Order Forms

Date:

05-19-2012

Company Name:

Contact Name:

Address:

City:

State:

Zip:

Phone:

Fax:

E-Mail Address:

Purchase Order:

How did you find us:

THE "TRIKLER" ORDER FORM
Quanity	Size	Individual	Total
	5.5 GPM	$ 5.50	$ 0.00
	5.0 GPM	$ 5.50	$ 0.00
	4.0 GPM	$ 5.50	$ 0.00
	3.0 GPM	$ 5.50	$ 0.00
	2.0 GPM	$ 5.50	$ 0.00
	1.5 GPM	$ 5.50	$ 0.00
	1.0 GPM	$ 5.50	$ 0.00
	.75 GPM	$ 5.50	$ 0.00
	.50 GPM	$ 5.50	$ 0.00
	.25 GPM	$ 5.50	$ 0.00
	STARTER KIT	$ 27.50	$ 0.00

TRIKL/AIR - ORDER FORM
Quanity	Size	Individual	Total
	5.5 GPM	$ 6.75	$ 0.00
	5.0 GPM	$ 6.75	$ 0.00
	4.0 GPM	$ 6.75	$ 0.00
	3.0 GPM	$ 6.75	$ 0.00
	2.0 GPM	$ 6.75	$ 0.00
	1.5 GPM	$ 6.75	$ 0.00
	1.0 GPM	$ 6.75	$ 0.00
	.75 GPM	$ 6.75	$ 0.00
	.50 GPM	$ 6.75	$ 0.00
	.25 GPM	$ 6.75	$ 0.00
	STARTER KIT	$ 33.75	$ 0.00

Starter Kits" contain one (1) each of sizes 4.0, 3.0, 2.0, 1.0, and 0.5 gpm.

THE "AIR HAMMER"
Unit Price	Quantity	Total
$229.00		$ 0.00

Total Cost: $ 0.00
PLEASE HAVE A SALESMAN CONTACT ME REGARDING A WASTE WATER TREATMENT SYSTEM

There is a $35.00 minimum order required. Orders ship via UPS.
Shipping and handling charges will be added to your invoice.