PURCHASE ORDER REQUEST FORM
Date: _________________________
Name: ________________________________________________
Company: ______________________________________________
Shipping Address:
__________________________________________
City, State, Zip:
___________________________________________
Phone:
______________________
Email: ___________________________________________________
Make Check or Money Order Payable to
Karen Wassmer
2004 Orange Picker Road
Jacksonville, Florida 32223
(904) 268-9200
Signature ______________________________________________________________
VMCE002
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Varroa Mite Control Entrance Brush
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Product Number
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Product Description
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QTY
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Cost Per
Brush
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Total
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QTY 1-5
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15.50
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QTY 6 - 15
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15.00
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QTY 16- 30
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14.00
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QTY 31- 100
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email for price
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Pricing Chart
QTY 1-5
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6.50
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QTY 6 - 10
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13.00
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QTY 11- 30
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19.50
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QTY 31- 100
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26.00
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Shipping Rate