RAIN
BARREL DIVERTERS BY
WATERTITE
ORDER FORM This order form may be printed and FAXED to 425.277.0287 or MAILED to 16627 SE 128th ST, Renton WA 98059
| BILL TO: | SHIP TO: |
| Name: | Name: |
| Address: | Address: |
| City/State/zip | City/State/zip |
Payment
Method
| CHECK | CREDIT CARD |
| Check or Card number: | Amount Enclosed: | |
| Type of card: | Exp Date: | Security Code: |
| Tax Exempt?: Yes No | Exemption Number: |
| Phone Number: | E-mail Address: |
| Fax Number: | Date Ordered: |
Please Supply the Following items: Click Here to View Color Chart
| ITEM NO. | DESCRIPTION | COLOR | QTY | UNIT COST | TOTAL AMOUNT |
| D2x3 | 2x3 Inch Diverter | $29.95 | |||
| OS2x3 | 2x3 Inch Offset Elbow | $6.95 | |||
| EL2x3 | 2x3 Inch Regular Elbow | $4.35 | |||
| D3x4 | 3x4 Inch Diverter | $41.95 | |||
| OS3x4 | 3x4 Inch Offset Elbow | $8.95 | |||
| EL3x4 | 3x4 Inch Regular Elbow | $5.35 | |||
| SUBTOTAL: | |||||
| Ordered By:________________________________________ | SHIPPING
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| WA Residents Add 8.8% Tax | |||||
| Approved By:________________________________________ |
TOTAL DUE: |
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