Bissell 8975 BISSELL CleanView Order Form, Order Information, Billing Information, Or Fax To

BISSELL CleanView Order Form

1 Order Information 3 Shipping Information

Item	Part No.	Part Name	Qty. x	Unit	=	Total
				Price
1	32074	Style 7 Drive Belt (2 pack)	______	$2.99	______	______
2	203-1007	Headlight Bulb	______	$1.95	______	______
3	203-1063	Crevice Tool	______	$2.99	______	______
4	203-1083	Dusting Brush	______	$1.70	______	______
5	203-1084	Extension Wand	______	$1.50	______	______
6	203-1164	Vacuum Hose	______	$8.95	______	______
7	203-1036	Wire Reinforced
		Vacuum Hose Gray	______	$12.95	______	______
8	203-2012	Wire Reinforced
		Vacuum Hose Clear	______	$14.95	______	______
9	203-2032	Brush Roll	______	$15.95	______	______
10	203-2013	Power Trak Brush Roll
		(Select Models Only)	______	$17.95	______	______
11	203-1085	Upper Tank Filter	______	$1.50	______	______
12	203-1073	Pre-Motor Filter	______	$1.50	______	______
13	203-1009	Post-Motor Filter	______	$2.95	______	______
14	32076	HEPA Media Post-Motor
		Filter (Select Models Only)	______	$9.99	______	______
					SUB TOTAL	______
Sales tax based on delivery address					Shipping	______
AR, AZ, CA, FL, GA, IL, KS, MA, MD, MI, MN, MO,
NC, NE, NJ, NY, OH, PA, TN, TX, UT and WA
residents add applicable sales tax.					Sales Tax	______
Price applicable in continental United States only
Price subject to change without notice					Order Total	______

Ship To ____________________________

Address ____________________________

____________________________

City ____________________________

State ____________ Zip____________

Shipping and Handling

.01 to $4.99 = $2.95

$5.00 to $19.99 = $4.95 $20.00 to $99.99 = $7.95 $100.00 to $229.99 = $13.95 $230.00 and up = $25.95

UPS 2nd Day = above shipping amount + $5.75 UPS Next Day = above shipping amount + $19.95

2Billing Information

Charge:		Mastercard				Enclosed in your envelope
						check or money order
		Visa				payable to BISSELL Homecare, Inc.
		American Express				(No cash or stamps please)
		Discover
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

OR FAX TO:

1-616-791-771115