Quantity	Product	Unit Price	Subtotal
_____	Spinout: Paint Roller Cleaner	$19.95	_______
_____	New Jersey only add 6% tax	$1.20	_______
	Shipping & Handling	$6.50	_______
		Total Cost	_______

Method of Payment:

___ Check Enclosed Check #: ___________

___ Credit Card ___ Visa ___ Discover ___ MasterCard ___American Express Card #: _________________________ Expiration Date: __________ Signature: _______________________

Mailing Address: Name: ____________________________ Company: __________________________ Address Line 1: ______________________ Address Line 2: ______________________ City, State: _________________________ Zip: ___________________ Email: _____________________________

Billing Address:     ___ If same check here Name: ____________________________ Company: __________________________ Address Line 1: ______________________ Address Line 2: ______________________ City, State: _________________________ Zip: ___________________

Mailing Instructions: Please mail or fax the completed form to: Spinout USA 610 Calvin Street Washington Township, NJ 07676 Fax: (201) 666-6063

For further information: Call us: (201) 406-3337 Email us: Visit us on the web: http://www.spinoutusa.com