BILLING NAME & ADDRESS
Name:
Address:
 
City:
State:
Zipcode:
Phone:
Email:
ORDER FORM
SHIPPING ADDRESS: if different from billing address
Name:
Address:
 
City:
State:
Zipcode:
Phone:
Email:
Please print and fill out this form. When complete please fax to: 1-515-270-8259.  Questions? Please call 515-360-7413. Thank you.
DESCRIPTION QTY UNIT PRICE TOTAL
CHROME & GLASS POLISH - 16 OZ   $7.95  
DEGREASING CLEANER - 22 OZ   $6.99  
SHOW SHINE - 22 OZ   $7.95  
       
    SUBTOTAL  
*6% Sales Tax - Iowa only   SALES TAX*  
VISA OR MASTERCARD CARD NUMBER
EXPIRATION DATE CVV NUMBER - 3 Digit number on back of card
NAME ON CARD  
   
CREDIT CARD INFO
SIGNATURE ____________________________________________
TL PRODUCTS
P.O. Box 7765
Des Moines, IA 50323
phone 515-360-7413
fax 515-270-8259
    Shipping 1st item** $9.95
***example: total items ordered -  7 then this line would be $6.00   each add'l item $1.00***  
    HANDLING $1.50
    TOTAL  
**ORDERS OVER $100.00 RECEIVE FREE SHIPPING