Degloss.com Order Form

Fill out the form below, then print and sign it before sending by FAX or mail.

Billing Address Shipping Address Same as Billing Address
First Name First Name
Last Name Last Name
Address Address
Apt./Unit Apt./Unit
City City
State/Prov. State/Prov.
Zip/Postal Zip/Postal
Country Country
Phone Phone
E-mail E-mail
Description Shade QTY Price
Each 		Total
Light Medium Tan
Matt's
Original
Deglosser		           $6.95
Executive
Matt		           $6.95
Postage & handling $2.50  
WI residents add 5.5% sales tax
Total

Charge my VISA    Master Card
Card No. - - -
Expiration Date /      Signature                                                                            
   (Please sign after printing order form)