Name:

Billing Address:

Phone Number:

Email:

Item

Unit Price

Quantity

Total

32-ounce WEE CLEANER

$14.99

 

1 gallon WEE CLEANER

$29.99

 

Sub-Total

  

Shipping - $7.95 flat shipping

 7.95

GRAND TOTAL

  

Payment Type:

Check or money order (make payable to Wee Cleaner)

Credit card:

American Express

Visa

Mastercard

Discover

Name on card:

Card Number:

Expiration:

/     (mm/yy)

Signature: