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.
| Quantity | Price | Shipping & Handling | Cost, Non-AR Resident | AR Sales Tax | Cost, 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 | |||||
| 10% Discount for Buying a Case (12) | |||||
| 12 | $324.00 | $24.00 | $348.00 | $27.14 | $375.14 |