Roxatone - Product Order Form
(if you wish to print and fax form
click here
)
Company Name:
Ordered By:
Billing Info:
Street:
City:
State/Prov:
Country:
Zip/Postal Code:
Telephone:
Fax:
Email:
Website: HTTP://
Ship To:
Same:
Street:
City:
State/Prov:
Country:
Zip/Postal Code:
Telephone:
Contact:
P.O. Number:
Quantity
Product
Color
Price /Gal
Shipping
Total Price
Roxatone
Roxatone
Method of payment:
Visa:
MC:
Other:
Credit Card #:
Expiry Date:
Month:
Year:
Name as it appears on Card:
T
he above card holder authorizes Sky Coatings Inc. to debit the credit card mentioned above in the amount specified and agreed upon by both parties. These charges include any and all costs discussed and agreed upon in accordance with the purchase agreement between Sky Coatings Inc. and the purchaser. All amounts specified are in US funds (except in Canada). Any costs related to the replacement of damaged or lost material that may occur during shipping shall be incurred by the purchaser. Sky Coatings Inc. assumes no responsibility for lost or damaged material and is not liable for any costs associated with this occurrence.
..
