Order Form
Please use this secure order form to order online
(this order form uses 128-bit encryption for your security).
Shipping Information
(red indicates required information)
Full Name
Address
City
State
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip Code
Email Address
Phone Number
In case we need to contact you.
Product Order
SpritzWiz System ($ 24.99 ea) :
0
1 ($ 24.99)
2 ($ 49.98)
3 ($ 74.97)
4 ($ 99.96)
5 ($ 124.95)
6 ($ 149.94)
7 ($ 174.93)
8 ($ 199.92)
9 ($ 224.91)
10 ($ 249.90)
SpritzWiz Body ($ 12.00 ea) :
0
1 ($ 12.00)
2 ($ 24.00)
3 ($ 36.00)
4 ($ 48.00)
5 ($ 60.00)
6 ($ 72.00)
7 ($ 84.00)
8 ($ 96.00)
9 ($ 108.00)
10 ($ 120.00)
Magnet Assembly ($ 12.00 ea) :
0
1 ($ 12.00)
2 ($ 24.00)
3 ($ 36.00)
4 ($ 48.00)
5 ($ 60.00)
6 ($ 72.00)
7 ($ 84.00)
8 ($ 96.00)
9 ($ 108.00)
10 ($ 120.00)
O-Rings pkg of 5 ($ 3.00 ea) :
0
1 ($ 3.00)
2 ($ 6.00)
3 ($ 9.00)
4 ($ 12.00)
5 ($ 15.00)
6 ($ 18.00)
7 ($ 21.00)
8 ($ 24.00)
9 ($ 27.00)
10 ($ 30.00)
Filter Washers pkg of 5 ($ 3.00 ea) :
0
1 ($ 3.00)
2 ($ 6.00)
3 ($ 9.00)
4 ($ 12.00)
5 ($ 15.00)
6 ($ 18.00)
7 ($ 21.00)
8 ($ 24.00)
9 ($ 27.00)
10 ($ 30.00)
Washers pkg of 5 ($ 2.00 ea) :
0
1 ($ 2.00)
2 ($ 4.00)
3 ($ 6.00)
4 ($ 8.00)
5 ($ 10.00)
6 ($ 12.00)
7 ($ 14.00)
8 ($ 16.00)
9 ($ 18.00)
10 ($ 20.00)
Sales tax :
CO residents add 4.75% tax
Shipping and Handling :
Shipping and handling is based on the total weight of your order. We ship USPS Parcel Post. You will receive an email confirmation with the total amount of your order.
Comments/
Instructions
Credit Card Information
Credit Card Type
Visa
MasterCard
Credit Card Number
Expiration Date
Month
1 - Jan
2 - Feb
3 - Mar
4 - Apr
5 - May
6 - Jun
7 - Jul
8 - Aug
9 - Sep
10 - Oct
11 - Nov
12 - Dec
Year
2006
2007
2008
2009
2010
2011
2012
2013
2014
Three digit ID (back of card)
Please note that the purchase will appear as
"SpritzWiz"
on your credit card.
Send email to
info@spritzwiz.com
with questions or comments about this web site.
Copyright © 2006 Q Industries, LLC. All rights reserved.