Septic Tank Treatment Order Form

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You can print out this form and fax it to 870-732-0041.
Just write the amount you want to purchase in the comments field.

First Name (required)
Last Name (required)
Organization
Address Line 1 (required)
Address Line 2
City (required)
State (required)
Postal Code (required)
Phone Area Code (required)
Phone Number (required)
Fax Area Code
Fax Number
Email Address
Card Type
Visa, Mastercard
American Express, Discover
Cardholder’s Name
Card Number
Do Not Use Dashes/Hyphens in the CC#
Expiration Date

Comment Field
You can type your order information manually here, or use the drop-down box above.
If you are an Arkansas resident, please remember that you must pay Sales Tax.


QuantityPriceShipping &
Handling
Cost, Non-AR
Resident
AR Sales TaxCost,
AR Resident
1$30.00$5.00$35.00$2.51$38.51
2$60.00$8.00$68.00$5.03$73.03
3$90.00$10.00$100.00$7.54$107.54
4$120.00$11.00$131.00$10.05$141.05
5$150.00$13.00$163.00$12.56$175.56
6$180.00$14.00$194.00$15.08$209.08
7$210.00$16.00$226.00$17.59$243.59
8$240.00$17.00$257.00$20.10$277.10
9$270.00$20.00$290.00$22.61$312.61
10$300.00$21.00$321.00$25.13$346.13
11$330.00$23.00$353.00$27.64$380.64
12$360.00$24.00$384.00$30.15$414.15
10% Discount for Buying a Case (12)
12$324.00$24.00$348.00$27.14$375.14

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