Product Order Form

Two Easy Ways to Place an Order:

Call (909) 472-8384
Email and scan this completed form to infernoman.mb@gmail.com

Quantity

Item Description

______

Metal Polish $16.00 ea. bottle

______

Spray Wax $15.00 ea. bottle | $40.00 ea. gallon

______

Rubber Life Protectant $15.00 ea. bottle | $40.00 ea. gallon

______

Shur Shine Glass Cleaner $4.00 ea. bottle | $10.00 ea. gallon

______

Creme Wax $20.00 ea. bottle | $120.00 ea. gallon

*Discounts are available for larger quantities. Please call or email for details.

Accepted Payment Methods: ___ Cash ___ **Check ___ Purchase Order No. _________
___ Visa ___ Mastercard ___ American Express ___ Discover
Card Number: ____________________________ Exp. Date ___________ CVC Code: _____
Month / Year
Billing Address: ____________________________ ________________ _______ ________
Street
City
State
Zip Code
If mailing address for product delivery is not same as the billing address, please complete
below:
Billing Address: ____________________________ ________________ _______ ________
Street
City
State
Zip Code
** Orders by check cannot be shipped until company check funds have cleared the financial institution.