PRINTABLE ORDER FORM
Fax to: 619-334-6936 or Mail to: PO Box 1154 El Cajon, CA 92022
Name:____________________________
Phone:________________
Address:____________________________
City________________
State:_____
Zip:______
Select your order preference:
$9.94
$15.93
$86.25
One 8 oz. bottle of Poly Gold
Two 8 oz. bottles of Poly Gold
One case of 12-8oz. bottles of Poly Gold
$11.94
$18.93
$107.25
One 8 oz. bottle of Marine Poly Gold
Two 8 oz. bottles of Marine Poly Gold
One case of 12-8oz. bottles of Marine Poly Gold
Payment type:
Check
Credit Card
Money Order
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Name on card (print)
Card Number:
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Exp. Date
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