Print off this entire page and mail to: "Case Clamp Order" Offer Case Clamp 41891 830th Ave. Bird Island, MN 55310

"Case Clamp" Mail in Order Form. _____________________________________________________________________

NAME (please print)____________________________

Address:_____________________________________

Address line 2:________________________________

City_______________________ State__________ Zip_______________

Email (optional)_______________@________________ For shipping notification and future Case Clamp customer contact info.

Phone #(____)______-___________ Only used if we have additional questions.

NONE!!! of the information you submit will be sold, or given to any third parties. It is intended for the sole purpose of Case Clamp customer sales.

PLEASE SEND ME: _____individual "Case Clamps"

Each individual Case Clamp is $13.95 (tax is included). Shipping costs are $4.95 per order. Total for (1) Case Clamp would be $18.90. Total for (2) orders would be $32.85. Order more than 5 and qualify for a 'TEAM' discount of $10.00! per Case Clamp. Simply adjust your total to $10.00 per Case Clamp. 5 Case Clamps w/shipping will total $54.95.

I HAVE ENCLOSED PAYMENT IN THE AMOUNT OF $__________

Please Check payment method: ___CHECK ___ MONEY ORDER

Please check here ___ if you are referring our product to a friend so that we may better thank you!

THANK YOU FOR YOUR ORDER!

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