Driwash Secure Order Form

StarLite NO-WET Products
Order From

Please fill out the following form to place your order. After you have completed the form, you can submit your order electronically by clicking on the button at the bottom of this page. If you do not feel comfortable transmitting your information over the internet, simply print the completed form and FAX it to: 856-467-7931.

Item	Quantity	Price each	Total Price
NO-WET 32oz. (includes one empty 8oz micromist applicator)		$34.95 or two for $64.90 a savings of more than $15!
Additional Micromist 8oz Spray Bottle (empty)		$4.00 each
Sub-Total
PA & NJ Residents Add 6% Sales Tax
Shipping & Handling (See Below) Enter "FREE" for orders over $64.
ORDER TOTAL

All prices are in US Dollars only. Payable by Check or Credit Card.
Please make checks payable to Pedrick & Adelsberg
and mail with your complete order form.

Shipping & Handling
If your TOTAL Order is...	Add for S&H	If your TOTAL Order is...	Add for S&H
Up to - $35.00	$5.95 (minimum)	$100.01 - 150.00	$13.95
$35.01 - 50.00	$7.95	$150.01 - 200.00	$15.95
$50.01 - 75.00	$8.95	$200.00 and over	will quote price
$75.01 - 100.00	$10.95
Alaska and Hawaii residents: please add $5 to the standard shipping charges.
Next Day & Two Day shipping is available for rush orders. Please call for quote.
International Customers: Non-U.S. customers, click here for important information. Billing Information Privacy policy: We do not furnish any customer contact information outside of our company. It is our policy to maintain the confidentiality of our customer database. Last Name First Name M.I. (Input your name EXACTLY as it appears on your credit card.) Street Address Apartment # City State ZIP Code Daytime Phone Evening Phone (In case we need to contact you about your order.) Email address

Shipping Information
Click here if the "SHIP TO" address is the same as the "BILL TO" address above.
If not, please provide the Shipping Information:
Last Name       First Name  M.I. 
Address 1      
Address 2      
City            State  ZIP Code

Payment Method

Select Payment Method: If payment is by check: Make check payable to Pedrick & Adelsberg, Inc., Print this completed form, and Mail the form with the check to:

                            Pedrick & Adelsberg, Inc.
                            StarLite Golf and Sports
                            314 Lake Side Drive
                            Swedesboro, NJ 08085

If payment is by credit card: Select card type:

Card # Exp. Date
Issuing Bank
PLEASE REVIEW BEFORE SENDING!

Did you correctly input your name and address?

Did you correctly input your credit card information?

Did you correctly input your phone numbers?

Did you enter your FULL e-mail address?

luke

Billing Information

Shipping Information

Payment Method