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| BISSELL CleanView Order Form |
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| Shipping Information | ||
1 | Order Information |
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Item | Part No. | Part Name | Qty. | x Unit | = | Total | Ship To ____________________________ | ||
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1 | 32074 | Style 7 Drive Belt (2 pack) | ______ | $2.99 | ______ | ______ |
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2 | Headlight Bulb | ______ | $1.95 | ______ | ______ | Address ____________________________ | |||
3 | Crevice Tool | ______ | $2.99 | ______ | ______ |
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4 | Dusting Brush | ______ | $1.70 | ______ | ______ |
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5 | Extension Wand | ______ | $1.50 | ______ | ______ | City | ____________________________ | ||
6 | Vacuum Hose | ______ | $8.50 | ______ |
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7 | Vacuum Hose Clear |
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| State | ____________ Zip____________ | ||
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| (Select Models Only) | ______ | $9.50 | ______ | ______ | ||
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| Brush Roll | ______ | $15.95 | ______ | ______ |
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| (Select Models Only) | ______ | $17.95 | ______ | ______ |
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10 | ______ | $1.50 | ______ | ______ | Shipping and Handling | ||
11 | ______ | $2.95 | ______ | ______ | .01 to $4.99 = $2.95 | ||
12 | 32076 | HEPA Media |
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| $5.00 to $19.99 = $4.95 |
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| $20.00 to $99.99 = $7.95 | |||
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| Filter (Select Models Only) | ______ | $9.99 | ______ | ______ | |
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| $100.00 to $229.99 = $13.95 | |||||
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$230.00 and up = $25.95
| SUB TOTAL | ______ |
Sales tax based on delivery address | Shipping | ______ |
AR, AZ, CA, FL, GA, IL, KS, MA, MD, MI, MN, MO, |
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NC, NE, NJ, NY, OH, PA, TN, TX, UT and WA |
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residents add applicable sales tax. | Sales Tax | ______ |
Price applicable in continental United States only |
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Price subject to change without notice | Order Total | ______ |
UPS 2nd Day = above shipping amount + $5.75 UPS Next Day = above shipping amount + $19.95
2Billing Information
Charge: |
| Mastercard |
| Enclosed in your envelope |
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| check or money order |
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| Visa |
| payable to BISSELL Homecare, Inc. |
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| American Express |
| (No cash or stamps please) |
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| Discover |
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Telephone | ________________________________________________________ | |||
Account
Number
(include all digits)
Card
Expires
Month | Year | Signature __________________________________ |
Or visit BISSELL website - www.bissell.com
MAIL REORDER FORM TO:
BISSELL Homecare Inc.
Mail Order Department
PO Box 3606
Grand Rapids MI 49501
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OR FAX TO:
