Ordering Information - print this form it will be two pages - use 1 sheet of paper on both sides (or you can "Edit", "Select All", "Copy" and "Paste" into Word or other program and fill in the info) and mail it with payment (check, money order, MasterCard, Visa), fax it with credit card info, e-mail with info or call us and we can do it the old fashioned way.

NAME _______________________________________________________

ADDRESS _____________________________________________________

CITY, STATE ____________________________________ ZIP __________

PHONE ______________________ E-MAIL _________________________

YEAR ___________ MAKE _________________ MODEL _____________

PAINT CODE _________________ COLOR NAME _____________________

PAYMENT OF $___________________ IS ENCLOSED - PERSONAL CHECK ____ MONEY ORDER ____

- OR-

PLEASE USE MY CREDIT CARD: VISA ____ MASTERCARD ____

ACC'T # ______________________________________ EXP DATE _________

SIGNATURE ____________________________________________________

QUANTITY / PRODUCT REQUESTED PRICE EACH TOTAL

____ B-I-C BOTTLES COLOR @ 7.98 = _______________

____ B-I-C BOTTLES CLEAR @ 6.98 = _______________

____ B-I-C BOTTLES PRIMER @ 5.98 = _______________

____ B-I-C BOTTLES RUST REMOVER @ 4.98 = _______________

____ 12 oz SPRAY COLOR @ 14.98 = _______________

____ 12 oz SPRAY CLEAR @ 12.98 = ________________

____ 16 oz SPRAY COLOR @ 19.98 = ________________

____ 16 oz SPRAY CLEAR @ 16.98 = ________________

____ 12 oz SPRAY FILL/SAND PRIMER @ 8.98 = ________________

____ COLOR & CLEAR SPRAY CAN COMBO (1.00) = ________________

TOTAL PRODUCT = _________________

FLORIDA ADD 6% SALES TAX = _______________

SHIPPING & HANDLING Modified - 6-18-07 to reflect new rates - affects only first spray can

____ BRUSH IN CAP BOTTLES (FIRST) @ 3.50 = _____

____ additional bottles @ 2.50 = _____

____ SPRAY CANS (FIRST) @ 6.30 = _____

____ additional cans @ 4.30 = _____

TOTAL ENCLOSED ________________

For More Information Contact:

NMB PAINT SALES
15520 W Dixie Hwy

N Miami Beach, FL 33162

Tel: 305.944.2833 // 800.281.0973 FAX: 305.944.3382

E-MAIL: INFO

Latest update: Jan 22,2007