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Secure Mail / Fax / Phone Order Form (Just click on the "Print" icon in your browser window above to use this form) Wipe Out Mold System 30-Day FREE Trial Offers _____ Advanced Wipe Out Mold System: Just $20.01 to cover Shipping & Handling _____ Basic Wipe Out Mold System: Just $18.97 to cover Shipping & Handling |
| Wipe Out Mold Systems | Price | Qty. | Amount |
| Advanced Wipe Out Mold System (Audio) | $279.91 + $20 S&H | _________ | $____________ |
| Advanced Wipe Out Mold System (CD) | $309.91 + $20 S&H | _________ | $____________ |
| Basic Wipe Out Mold System (Audio) | $149.97 + $20 S&H | _________ | $____________ |
| Basic Wipe Out Mold System (CD) | $179.97 + $20 S&H | _________ | $____________ |
| "Mold Buster" Videos | Price | Qty. | Amount |
| Basic Wipe Out Mold System (Audio) W/Mold Buster Video | $189.92 + $20 S&H | _________ | $____________ |
| Basic Wipe Out Mold System (CD) W/Mold Buster Video | $219.92 + $20 S&H | _________ | $____________ |
| Homeowners & Tenants "Mold Buster" Video | $99.97 + $10 S&H | _________ | $____________ |
| Landlords "Mold Buster" Video With Forms | $169.95 + $10 S&H | _________ | $____________ |
| Locating Mold In Your Home Or Building | Price | Qty. | Amount |
| 5-Minute "Instant Results" Mold Test (includes 2 tests) | $89.97 + $11 S&H | _________ | $____________ |
| Advanced "Airborne" Mold Test (includes 2 tests) | $119.97 + $11 S&H | _________ | $____________ |
| Cleaning Black Mold | Price | Qty. | Amount |
| Black Mold Cleaner (1 Gallon) | $44.95 + $13.50 S&H | _________ | $____________ |
| Black Mold Fogger | $289.95 + $28.50 S&H | _________ | $____________ |
| Preventing Mold Growth | Price | Qty. | Amount |
| Hoover Commercial HEPA Vacuum | $430.98 + $52 S&H | _________ | $____________ |
| EPA Registered Air Treatment System | $1,099.00 + $110 S&H | _________ | $____________ |
| Shower Gutter | $34.97 + $6 S&H | _________ | $____________ |
| Total Before Tax & Shipping | $___________ |
| Shipping & Handling | $___________ |
| Grand Total | $___________ |
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MAIL TO: 20428 65th Dr. NE Arlington, WA 98223 |
To get your order processed immediately call: (360) 435-4508 or fax: (360) 435-4561 with your credit card information |
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Billing Address: Name:__________________________________________ Address:________________________________________ City:___________________ State:_______ Zip:________ Telephone: (In case we have a question about your order) Daytime: ( _______) ______________________________ |
Ship To (if different from billing address): Name:__________________________________________ Address:________________________________________ City:___________________ State:_______ Zip:________ Email:__________________________________________ Evening: ( _______) ______________________________ |
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Method Of Payment: ___Visa ___M/C ___Amex ___Discover ___Check / Money Order payable to: Maximum Response Marketing |
Card Number:_________________________________________ Expiration Date:______________________ Signature:_____________________________________________________ |