ORDER FORM

Click File then Print to print form or see below for other ordering choices

SHIP TO:

Name _______________________________________________________________
Address _____________________________________________________________
City ____________________________	State ________	Zip ______________
Phone ( _____ ) _________________________

Qty Product Item Color Price Total Sub Total Tax (TX Res. add .0825% sales tax) Shipping & Handling Total Method of Payment - Please Check One Check or Money Order Visa MasterCard Account Number

Card Expiration Date: ____ /____ Signature: ____________________________________
Month/Year Signature required on charge orders by mail.

Shipping & handling $7.50 per unit - Texas residents add sales tax

Mail orders to: SAFE-T-BRITE 1301 E. Henderson Cleburne, Texas 76031 or Call in your order: 817-558-0771

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