PRINT OUT THIS FORM, fill in appropriate areas, and Telephone, FAX or mail to:

TM

Retail Direct
Customer Order Form - CANADA
Ronald Weitz
Independent Distributor
P.I.N. # 117054

DWG INTERNATIONAL
P.O. Box 98867
Las Vegas, NV 89193-8867
CALL TOLL-FREE 1-800-820-6893
FAX to (702) 262-5550

DATE:

FOR OFFICE USE:

CUSTOMER INFORMATION

SHIP TO INFORMATION (If Different)

ACCT #

Distributor PIN # 117054

( ) Check here to use CUSTOMER INFORMATION as SHIP TO

NAME:

NAME:

ADDRESS:


ADDRESS:


CITY:

CITY:

STATE:

ZIP CODE:

STATE:

ZIP CODE:

PHONE:

PHONE:

ITEM
CODE

D E S C R I P T I O N

QTY

PRICE EACH

TOTAL PRICE

1010

DRI WASH 'n GUARDTM for Auto - 32 oz. (Includes 8 oz. Pump Bottle)

.

$48.95 CN

.

1020

DRI WASH 'n GUARDTM for Auto - 64 oz. (Excludes 8 oz. Pump Bottle -see #2002 to purchase)

.

$88.95 CN

.

1025

DWG Upholstery, Fabric & Carpet Treatment -16 oz.

.

$12.95 CN

.

1050

DWG Leather & Vinyl Treatment -- 16 oz.

.

$12.95 CN

.

1060

DWG Premium Metal Polish -- 12 oz.

.

$17.95 CN

.

1070

DWG All-Weather Tire Treatment -- 16 oz.

.

$17.95 CN

.

1035

DWG All-Weather Tire Treatment -- 69 oz.

.

$59.50 CN

.

1090

DWG PolyGuard-1™ Oil Treatment -- 8 oz.

.

$21.55 CN

.

1150

DWG OxyGone-1™ -- 8 oz.

.

$13.95 CN

.

1155

DWG OxyGone-1™ -- 64 oz.

.

$86.95 CN

.

1160

DWG Dust B' Gone-1™ -- 8 oz.

.

$12.95 CN

.

2002

DWG Waterless Car Wash Empty 8 oz. AIRosols

.

$5.00 CN

.

2230

BodyPruf Total Body Care Formula - 16 oz.

.

$20.95 CN

.

2320

BP Antibacterial Waterless Handwash - 4 oz.

.

$11.95 CN

.

2325

BP Antibacterial Waterless Handwash - 32 oz. Refill

.

$80.75 CN

.

2255

BodyPruf Enviro-Shield -- 4 oz.

.

$22.35 CN

.

PAYMENT INFORMATION

Product SubTotal

( ) Check # _________ ( ) Money Order ( ) ______________________
( ) Charge my credit card: ( ) VISA ( ) Master Card ( ) AMEX ( ) Discover


Credit Card # __________________________


Exp. Date: _____/_____ Signature: _X________________________


Card Holder: __________________________

Shipping & Handling
Greater of 5% of Product Total or $8.95 

Sub Total

Sales Tax
Enter the tax at your local tax rate

TOTAL

Prices subject to change without notice. Business opportunities are available with these product lines.