Please print this form, fill out, and mail to:

Black Magic Cleaners

DIVISION OF MDS INC.
2997 South St.
East Troy, WI 53120
Phone or fax: 262-642-7121

Name:

Address:

City:

State:

Zip:

Phone:

Date:

Name:
Address:
City:
State:
Zip:
Phone:
Date:

Item Quantity Unit Price Amount

Lg: 5/8" dia. 1.50

Sm: 1/2" dia. 1.35

Mini: 3/8" dia. 1.10

Square: 3/8" sq. 1.10

3/4" x 3" x 3" Cleaning Pads .95

Stainless Steel Sculpturing Tool 3.50

12" x 12" Greenware Pillow 1.95

SUBTOTAL:

Quantity Discounts
(Sizes may be mixed.)
1 doz.: 20% discount
2 doz.: 30% discount
4 doz.: 40% discount
12 doz.: 50% discount
LESS DISCOUNT:

Min. Postage 2.75 plus:

TOTAL:

VISA or MC #:

Exp. Date:

Name as it appears on card:

Item	Quantity	Unit Price
Lg: 5/8" dia.	1.50
Sm: 1/2" dia.	1.35
Mini: 3/8" dia.	1.10
Square: 3/8" sq.	1.10
3/4" x 3" x 3" Cleaning Pads	.95
Stainless Steel Sculpturing Tool	3.50
12" x 12" Greenware Pillow	1.95
SUBTOTAL:
Quantity Discounts (Sizes may be mixed.) 1 doz.: 20% discount 2 doz.: 30% discount 4 doz.: 40% discount 12 doz.: 50% discount		LESS DISCOUNT:
Min. Postage 2.75 plus:
TOTAL:
VISA or MC #:
Exp. Date:
Name as it appears on card: