Ordering is easy!  You may...

• Submit this form and call us at (502) 412-7328 or toll free at 1-866-323-SEAT (7328) with your credit card information;
• Print and fax this order form with credit card information to (513) 444-2099; or
• Print and mail this order form with check or credit card information to:
• Purchase orders are accepted with approved credit.

hygo-tech, inc.
8003 Vine Crest Ave., Suite 8
Louisville, KY  40222

Customer Name:
Title:
Company:
Billing Address:
	City:	State:	Zip:
Ship-To Address: (if different from above)
	City:	State:	Zip:

Work Phone:
Fax:
Email Address:
Item	Quantity	Unit Price	Total Price
S2000 Hygolet Toilet Seats		$139.95
Replacement Rolls (box of 10)		$74.95
Master Case		$480.00 (80 rolls x 100 seats)
HygoBag Sanitary Dispenser		$12.00
HygoBag Sanitary Refills		$25.00
Air Freshener Neutralizer		$19.95
Can Air Freshener Neutralizer		$5.95
Can Air Freshener      Neutralizer Case		$58.20/case (12/case)
Automatic Flush Sensor      Toilet/Urinal		$199.95
Automatic Sensor Faucet-Sink		$299.95
Automatic Soap System		$74.95
The Wet Umbrella Stand		$54.95
B2000 Wet Umbrella Caddie		$104.95/case (2,000/case)
B1000 Wet Umbrella Caddie		$57.95/case (1,000/case)
The HygoMat Urinal Mat		$69.80 (12/case)

	Sub-Total
	Add 6% Sales Tax
	Add S&H
	(call us for S&H charge or, if you prefer, we will add the appropriate amount to your order)
	Grand Total
Yes.  I hereby authorize the Grand Total amount to be charged to my credit card.
Credit Card:	MasterCard Visa American Express
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Expiration Date:
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