Order Form

P.O. Box 4796
Sonora, CA 95370-4944
(209)588-0375
Toll Free U.S. (866)313-7273
Toll Free U.S. fax:(866)553-3675 kleenslate@kleenslate.com

First & Last Name:
Billing Street Address, City, State, Zip:
Shipping Street Address City, State, Zip:
E-mail:
Phone:
Fax:
Payment Method:	Check or Purchase Order	Visa
	MasterCard
Credit Card Number:		Expiration Date:

Quantity	Product	Sub-Total
	4 pack Lg. Erasers @ $3.99/pk
	4 pack Sm. Erasers @ $2.99/pk
	Container of 100 Large Single Erasers @ $99.00
	Container of 100 Small Single Erasers @ $75.00
	(LG) 4 pack Lg. Markers with Erasers - bullet tip (Red, Blue, Green & Black) @ $7.50/pk
	(SM) 4 pack Sm. Markers with Erasers -fine tip (Red, Blue, Green & Black) @ $6.50/pk
	24 Small Black Replacement Markers w/ Erasers @ $30.00
	24 Replacement Blank Circles for Paddles @ $24.00
	24 Replacement Lined Circles for Paddles @ $24.00
	Kwik ChekII Classroom Kit 24 Plastic, double-sided, hand-held white boards, each with integrated marker holder, 24 sm. markers & erasers, 4 pack Lg. markers, activity booklet, and storage box @ $130.00
	Kwik ChekII Classroom Kit 12 Plastic, double-sided hand-held white boards, each with integrated marker holder, 12 sm. markers & erasers, 4pack Lg. markers, activity booklet, and storage box @ $60.50
	Kwik Chek II 2-Pak: Set of two each 2 Plastic, double-sided, hand-held white boards with integrated marker holder, 2 sm. markers & erasers, @ $14.99
	Kwik Chek II Refurbish Kit 24 Small Black Replacement Markers with Erasers 24 Replacement Dry Erase Sheets (12 lined /12 blank) $54.00 complete
	SUBTOTAL
	Tax 7.75% for California residents:
	13% Shipping & Handling:
	TOTAL:

Once completed, please PRINT this page and fax to (866)553-3675
or mail to Kleenslate Concepts, P.O. Box 4796
Sonora, CA 95370-4944.