The Ultimate in Protective Masks

Order Form

Name:
Address:
City:
State:
Zip Code:
Country:
E-Mail Address:
(In the form "you@yourprovider.com")

Cold Air Mask: $13.00 plus $3.00 S&H   Qty:   Total: $16.00 ea.
Please select size &: --
Allergy Mask:$13.00 plus $3.00 S&H   Qty:   Total: $16.00 ea.
Please select size: -- Color is always beige.
Dust Mask:$5.75 plus $3.00 S&H     Qty:   Total: $8.75 ea.
Remember -- One Size Fits All!

Payment options:
Check, Money Order, Visa and MasterCard
Card Number:
Expiration Date:
If paying by check or money order, please send payment to the address at the bottom of this page.
Your order will be shipped upon receipt of payment.

     


AIR CLEAR, INC.
12601 Pleasant Grove #10
Syracuse, IN 46567
PHONE (574) 457-5237 -- FAX (574) 457-5937
Email address:mask@kconline.com
Sam & Marilyn Cole Owners & Operators

Copyright 1998 - 2001
®S&MC