Printable order form for Biozyme

BIOZYME                  Qty                     Each                                             Total

    32 OZ (1000ml) ______               19.95   ___ Plus Shipping          ______
            
         2-32 oz (2000ml) ______            29.95  ___  Plus Shipping       ______

                    1 Gallon ______           39.95    ___ Plus Shipping          ______

(Econo Pak)   4 Gallons ______          129.95  ___ Plus Shipping         ______






For Air shipping or Alaska/Hawaii/Canada - please Contact us - (503) 545-7234

DATE: ____________
Telephone # _________________________                                                                     Total =  _______

Please Circle One:       Check Enclosed                Visa                MasterCard              Discover

                 Card Number:       ________ - ________ - ________ - ________
           Expiration Date:  ________

                  Signature: ________________________________      


Shipping Address:                                                                Billing Address:
Name:    ________________________                    Name:  ______________________

Address:   _______________________              Address: _____________________
    
City, State,                                                          City, State,
Zip:        _______________________                         Zip: _____________________

Make check or money order payable to: Cleaners-r-us (US Dollars Only)
To calculate shipping charges to your address please do the following:  Click on item you are purchasing.
Next click on checkout and fill in your shipping address information. Click on continue and it will calculate the
shipping charges. After figuring out shipping charges there is no need to fill in billing information since you
are sending in your order at this time. Remember please send payment for total amount shown. If you have
any trouble please call us directly and we will be happy to help. (503) 545-7234     
Send your order to:
Cleanup, Inc.
P.O. Box 42329
Portland, OR 97242
To call in your order:
503.545.7234
Fax your order to:
503.233.9512