For Your Convenience:
Fill out this form online then Print and
Fax
it to
(830) 964-4646
or
Mail
your Order & Payment to:
AJP Chemical, 15377 FM 306, Canyon Lake, TX 78133
.
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Description
Size
(Click Button)
Price
(Each)
Quantity
(Type Number)
Total Each
(Input Amount)
Secret Potion - Pina Colada
Quart
$ 9.95
Gallon
$24.95
Secret Potion - Orange Vanilla
Quart
$ 9.95
Gallon
$24.95
Secret Potion - Lemon
Quart
$ 9.95
Gallon
$24.95
Secret Potion - Bay Berry
Quart
$ 9.95
Gallon
$24.95
Secret Potion - Cherry
Quart
$ 9.95
Gallon
$24.95
PSP - Car Polish
Quart
$10.95
PSP - Furniture Polish
Quart
$10.95
Subtotal of above Order:
Shipping Charges - Refer to Chart
(left)
Sales Tax -
Texas Residents Only - add 8.25%
Total:
$0.01 - $25.00
$8.95
$25.01 - $49.00
$14.95
$49.01 - $75.00
$22.95
$75.01 - $100.00
$29.95
$100.01 +
add 30%
*Payment Options
Visa
MasterCard
American Express
Discover *
Check
Money Order
Credit Card #
Expiration Date
_____________________________________
Signature Line Credit Card Authorization
(Form must be mailed for the Check or Money Order Box to be selected)
How did you hear about us?
Postcard
Flea Market
Brochure/Mailout
Advertisement
Website
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