| Hy-Tech Insulating Paints & Paint Additives: Print and FAX Order To: Hy-Tech:
321-984-1022 Or Mail to: Hy-Tech, P.O. Box 216, Melbourne, FL 32902, U.S.A. |
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Description
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Price Ea.
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Total Price
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Sub Total
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Shipping Cost (can be calculated
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Payment Method:
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_____ Visa
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_____ MC
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_____ AMEX
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_____ PayPal
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| Credit Card #:____________/____________/____________/____________ Expires: ____ /____ | ||||
| Using PayPal? | Your PayPal Account email | |||
| Please Print Name on card |
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Billing Address: |
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| Shipping Address: (if different from above) |
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| E-mail Address: | Daytime Phone Number (required): | |||
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CREDIT CARD AUTHORIZATION
I understand that I am authorizing Hy-Tech to charge my credit card for the purchase(s) I have made above. Signature:__________________________________________ Date:________________
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