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Contact
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Order Form
Rep name:
Dealer name:
Address
TAX ID number
Contact name
Website
Phone number
Email Address:
Dealer agrees to MAP price of $149
Yes
O-Care boxes
Price per box
How many?
27
US$ 83.00
54
US$ 81.00
81
US$ 79.00
108
US$ 76.00
Special offer
Price
How many?
1.
54 boxes + 27 Free Golden Sample Kits
2.
108 boxes + 54 Free Golden Sample Kits
Shipping costs
US$
Total
US$
O-Care Display
Yes
No
Brochures
Yes
No
Add to Water maintenance application
Yes
No
Add to O-Care Store Locator
Yes
No
Send Draft Subscription
Yes
No
Agreed upon with retailer
A. Free box for every new customer at point of installation
Yes
No
B. Free shipping to customers
Yes
No
C. $10 Product Discount for subscription auto-ship customers
Yes
No
D. $30 Commission to salesperson when selling subscription for auto-ship
Yes
No
Remarks
Name O-Care Representative
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