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MAIL/FAX ORDER FORM |
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or FAX TO: (801) 942-3323 |
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SHIP / BILL TO: |
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MAIL/FAX ORDER FORM |
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or FAX TO: (801) 942-3323 |
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SHIP / BILL TO: |
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Name |
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| Address | ............................................................................................................................. |
| City/State/Zip or Prov./PC | ............................................................................................................................. |
| Phone/ Fax | ............................................................................................................................. |
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| Method of Payment: | 
Prepay (make check or money order payable to Guyco Industries) Discover Mastercard
Visa |
Credit Card Information: |
Card Number: _________________________________ Expires: _________ Cardholder's Signature: ___________________________________________ |
| QTY | TITLE / DESCRIPTION | PRICE | TOTAL |
|---|---|---|---|
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HOT SHOTS Complete Kit 2 Boot Warmer Insoles, 2 low temp stretch cords, on-off power switch, 2 jacks/plug connectors, connection wire, complete instructions |
$59.95 ea. | ||
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Adjustable Heat Control Knob (optional) Provides a full range of heat control |
$18.95 ea. | ||
| Replacement Part: Boot Warmer Insole (left foot) | $20.50 ea. | ||
| Replacement Part: Boot Warmer Insole (right foot) | $20.50 ea. | ||
| Replacement Part: Low Temperature Stretch Cord | $9.50 ea. | ||
| Replacement Part: On-Off Power Switch | $2.50 ea. | ||
| Replacement Part: Jack (Plug Connector) | $0.75 ea. | ||
| Replacement Part: Connection Wire | $0.50 | ||
| Subtotal: | |||
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Shipping Calculation: $4.50 for subtotals of $0 to $80.00 $9.00 for subtotals of $80.01 to $180.00 $14.00 for subtotals of $180.01 to $250.00 Add an additional $5.00 for Canadian orders |
Shipping Amount: | ||
| Add Subtotal and Shipping Amount together | TOTAL AMOUNT: |
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