ORDER FORM

If you do not feel comfortable ordering online using your credit card, simply print out this order form & mail or fax it along with your check, money order or credit card information to:

Deer Out™
P.O. Box 290
South Plainfield, NJ 07080
(908) 769-4242      Fax: (908) 769-3253

Payment Method: ___ MasterCard   ___Visa

Card #: ___ ___ ___ ___-___ ____ ___ ___-___ ___ ___ ___-___ ___ ___ ____

Expiration Date: _____-_____ (mmyy)

Name on Credit Card: __________________________________________________

Billing Address:________________________________________________________

____________________________________________________________________

City: _________________________ State: ________ Zip Code/Postal Code: __________

Ship To Address (if different from Billing Address):___________________________________________________

______________________________________________________________________________________
IMPORTANT: We can't ship to P.O. boxes. Please be sure to provide a physical address for FedEx delivery.

City: _________________________ State: ________ Zip Code/Postal Code: __________

Phone: ____________________________Email: ____________________________________________________

 

Item	Price	Quantity	Total
40 oz Ready to Use Solution	$15.99 + $6.95 s/h	_____	$________
48 oz Ready to Use Pump Sprayer	$32.95 + $6.95 s/h	_____	$________
1 Gallon Ready to Use Solution	$26.99 + $9.95 s/h	_____	$________
32 oz Concentrate	$34.95 + $6.95 s/h	_____	$________
Starter Combo	$47.95 + $8.95 s/h	_____	$________
4 Gallons Ready to Use Solution	$99.00 + $12.95 s/h	_____	$________
1 Gallon Concentrate	$119.95 + free shipping	_____	$________
2 1/2 Gallon Concentrate	$199.99 + free shipping	_____	$________
5 Gallon Concentrate	$399.99 + free shipping	_____	$________
NJ Residents add 6.625% Sales Tax	$________
		ORDER TOTAL	$________

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