PERMA-SEAL  ORDER FORM

 Please select the product(s) you wish to order.
(ALL FIELDS ARE REQUIRED)  

ALL PRICES INCLUDE
SHIPPING & HANDLING

2 PC UNITS 12 PC CASE 24 PC CASE 50 PC CASE
ORIGINAL FORMULA POWDERED
PERMA-SEAL "THE LAZY MAN'S WAX"
$26.95
$100.00
$175.00
$275.00
CLEAR COAT FORMULA LIQUID
PERMA-SEAL HAND GLAZE
$26.95
$100.00
$175.00
$275.00
 3 SUPER ABSORBANT SYNTHETIC
CAMELBACK SUPER CHAMOIS
$23.00
$50.00
$90.00
$175.00
PERMA-SEAL CARPET, FABRIC &
UPHOLSTERY SHAMPOO
$26.95
$100.00
$175.00
$275.00
ULTRAVISION GLASS TREATMENT
NO LONGER AVAILABLE
discontinued
discontinued
discontinued
discontinued
    Yes, please send me the CAMELBACK
          DETAILING CLOTH!
          This is included, FREE OF CHARGE,
          courtesy of PMI.
TOTAL
non-PA Residents
(no sales tax)
TOTAL
PA Residents
(6% sales tax)

Please fill out the rest of the required information.

Please enter your Full Name and Billing Address.
(as it appears on your credit card statement)

Example:  John Smith
                         P.O. Box 2154
                               Albany, NY 23456


 

Enter your Full Name and Shipping Address.
(if different from your billing address)
   
       Example: 
John Smith
                                     124 Walnut Drive
                                Apartment #3E
                                     Albany, NY 23456

 

Now enter your Credit Card Number
 
Example:  1234123412341234

 

And the Expiration Date
 
Example: 
09/03

 

Please enter your phone number
 
Example:  (717) 555-1212

  

And your email address
(required for order confirmation).

 


Please review all entered information above.
  Once you are sure everything is entirely accurate, click on the
Submit Button.
(click on the submit button only ONCE)