Product Order Form

Instructions:

TIP: Please ensure you have all information available to complete your online form prior to filling it out - contact information, product name, code, description, color and number of packs. You may lose data that has been input if you leave the Order Form prior to submitting it.

Shortly after submitting an order, an automatic confirmation email from kostklip® will be sent to the email address entered, which will include the order details and the reference number.

Allow 1-2 business days for a kostklip® representative to contact you who will confirm your order, the ship date, and for security purposes, obtain the necessary credit card information to complete this purchase.

For any questions, please contact Customer Service at 1.800.661.5547 or email

Company Information

* indicates a required field
Business Name *
Billing Address *
P.O. Box / Suite / Unit
City *
Prov/State *
Country *
Postal/Zip Code *

Purchaser Information

Catalog Request

Yes, please send me a free catalog (complete if different from purchaser):

First Name *

First Name

Last Name *

Last Name

Title

Department

Phone *

Fax

Email *

Shipping Address

Freight Information

Select if Ship To address is same as Billing Address

Shipping Payment Method *

Pre-Paid Collect Bill / 3rd Party

Shipping Address

Freight Carrier

Bill To or 3rd Party Account #

City

Special Shipping Instructions

Prov/State

Country

Postal/Zip Code

Order

Product Name	Code	Description	Color	# of Packs

* I have read and agree to the Terms of Use:

All orders under $100.00 excluding freight and taxes, generates a $10.00 handling fee. Non-custom products can be returned within 30 days of purchase, subject to a 25% restocking charge. All product returns must be accompanied by a Return Material Authorization issued and approved in advance by kostklip®. Credit will not be issued for any unauthorized returns. Notice of an order cancellation must be made in writing to the Customer Service Supervisor. Cancellations will be reviewed and the customer may incur costs associated with the production and fulfillment of the order.

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