Lubrication Specialists Order Form

ORDER FORM
Please print this form and mail or FAX to:

Lubrication Specialists, Inc., 5151 Murphy Canyon Road, Suite 135
San Diego, CA 92123

Call : 858-565-2700 - FAX: (858) 565-7399

Until we get our secure order site up it is recommended you phone in your order

FORMULA 3^tm
Metal Conditioner

SIZE
QUANTITY

LIST PRICE

TOTAL

8 oz
_________

$ 16.95/bottle - Will treat an engine with 3-5 quarts of oil *

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Case (24 8oz Bottles.)
________

$ 345.00 **
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1 Gallon
________

$ 195.00 ***
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Sales Tax at 8%
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** 20% Savings over 8 oz bottle.
*** 31% Savings over 8 oz bottle.

* For maximum protection, we recommend 8oz per 3-5 qts. for the first treatment and then 4oz each oil change thereafter.

ORDER TOTAL
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Bill To:

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Credit Card. Please circle type.

Visa Card, Master Card, Discover, American Express

Card Number ___________________________

Expiration Date _____MO ______YR

Security Number _____
Ship To:

_____________________________________

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NOTES

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SIZE	QUANTITY	LIST PRICE	TOTAL
8 oz	_________	$ 16.95/bottle - Will treat an engine with 3-5 quarts of oil *	________________________
Case (24 8oz Bottles.)	________	$ 345.00 **	________________________
1 Gallon	________	$ 195.00 ***	________________________
		Sales Tax at 8%	_________________________
20% Savings over 8 oz bottle. * 31% Savings over 8 oz bottle. * For maximum protection, we recommend 8oz per 3-5 qts. for the first treatment and then 4oz each oil change thereafter.		ORDER TOTAL	_________________________