Order Form

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ORDER FORM
To Order, just print this form, complete it, and mail to:


CLEAR-SIGHT, INC.

220 Rosewood Court
Westmont, Illinois 60559 USA
Voice:  630-323-3590
Fax:  630-323-3591


E-mail any questions to:
paul.sherman@clean-n-brite.biz

Please send my order of CLEAN-N-BRITE to:
(Please Print)

Name:_____________________________

Street Address:______________________

City:______________________________

State:_____________Zip:_____________

Country: __________________________


Make checks payable to Clear-Sight, Inc.

___  Payment enclosed
          
 
___  Send C.O.D.
                  (add $5.00 for C.O.D.)
 
   
CLEAN-N-BRITE
 PRICE LIST
 

Quantity


Price
 

3 vials $ 14.95
6 vials $ 27.00
9 vials $ 38.25
12 vials $ 48.00
18 vials $ 69.30
24 vials $ 90.00
36 vials $ 126.00
48 vials $ 160.80

NOTE:
Add shipping & handling charge of
$ 4.99 per order