Order Form

Tel: 586-949-3527
Send completed form to:

Website: http://www.polymers.eezway.com/
E-Mail polymers@eezway.com
No telephone orders or purchase orders please.
Enter the information below Please print clearly!
Name: _______________________________________________
Address: _____________________________________________
Address: _____________________________________________

EEZWAY
45931 Edgewater Dr.
New Baltimore, MI 48047

City: _________________________________
State: ________________________ Zip: ______________
E-Mail: ________________________________

*Shipping charge applies only once per item#

Item #
Description
Shipping*
Polymer Sample Kit
Shipping: ($4.50 s&h + $1.00/ea. additional kit)*
POLYKIT
Polystyrene Refill
PS-2oz
Shipping:
($1.00 s&h)*
Polypropylene Refill
PP-2oz
Shipping:
($1.00 s&h)
Polyvinyl Chloride Refill
Shipping:
($1.00 s&h)*
PVC-2oz
Low Density Polyethylene Refill
LDPE-2oz
Shipping:
($1.00 s&h)*
High Density Polyethylene Refill
HDPE-2oz
Shipping:
($1.00 s&h)*
Polycarbonate Refill
Shipping:
($1.00 s&h)*
PC-2oz
Polyethylene Terephthalate
PETE-2oz
($1.00 s&h)*
Polymethylmethacrylate Refill
PMMA-2oz
Shipping:
($1.00 s&h)*
Nylon-66 Refill
Shipping:
($1.00 s&h)*
N66-2oz
Big Bands-Rubber Bands 1doz/pk 7x1/8 inch
Shipping:
($1.00 s&h + $0.50/ea. additional pk)
BB-12
Big Red-Rubber Bands 1doz/pk 8-1/2x1/4 inch
BR-12
Shipping:
($1.00 s&h + $0.50/ea. additional pk)

Shipping Sub-total (Enter Below)

*Shipping charge applies only once per item#

Quantity
$10.00ea x

$2.00ea x

$2.00ea x

$2.00ea x

$2.00ea x

$2.00ea x

$2.00ea x

$2.00ea x

$2.00ea x

$1.39pk x

$1.59pk x

Price

Sub-Total

Michigan addresses include 6% sales tax

Shipping
Please remit this amount with your order.

Total

Send completed order form along with your payment to:

EEZWAY
45931 Edgewater Dr.
New Baltimore, MI, 48047
Make checks and money orders payable to: EEZWAY. No telephone orders or purchase orders please.
Orders are shipped via the US Postal Service, Parcel Post. Please allow 2-3 weeks for delivery.

OrderForm.doc

9/4/2006