Bar Keepers Friend/Lisa Neace
1100 Waterway Boulevard
Indianapolis, Indiana 46202
Email: Lneace@barkeepersfriend.com FAX : 317-264-2192

Mailing Address:                                                                                                      Shipping Address (If different):
Name: ________________________________________________    Name:__________________________________________
Address:______________________________________________     Address:________________________________________
City:_________________________________________________      City: ___________________________________________
State: ______________________ Zip: ______________________      State: ____________________ Zip: __________________
Phone: ________________________________  Email: ____________________________________________________________

Payment Info. (circle one):       Check payable to : Bar Keepers Friend    Money-Order    MasterCard    Visa     Discover    American Express

Credit Card Number: _______________________________________________________      Expiration Date (ex. 10/10): _________

4 cans of Bar Keepers Friend  12 oz.	Price $6.00	Quantity_____	Total_______
12 cans of Bar Keepers Friend 12 oz.	Price $16.00	Quantity_____	Total_______
4 cans of Bar Keepers Friend 21 oz.	Price $8.50	Quantity_____	Total_______
12 cans of Bar Keepers Friend 21 oz.	Price $22.00	Quantity_____	Total_______
Bar Keepers Friend 25 lb box	Price $30.00	Shipping Included in Price	Total_______
Bar Keepers Friend 40 lb pail	Price $50.00	Shipping Included in Price	Total_______
250 1 oz. sample packs Bar Keepers Friend Powder	Price $30.00	Quantity_____	Total_______
Bar Keepers Friend Cleaning Bucket	Price $14.95	Quantity_____	Total_______
4 bottles of BKF Liquid 13 oz.	Price $5.00	Quantity_____	Total_______
12 bottles of BKF Liquid 13 oz.	Price $14.00	Quantity_____	Total_______
3 bottles of BKF Liquid 26 oz.	Price $6.75	Quantity_____	Total_______
9 bottles of BKF Liquid 26 oz.	Price $18.00	Quantity_____	Total_______
4 cans of Copper Glo Powder 12 oz.	Price $5.25	Quantity_____	Total_______
12 cans of Copper Glo Powder 12 oz.	Price $14.00	Quantity_____	Total_______
4 bottles of Copper Glo Liquid 13 oz.	Price $5.25	Quantity_____	Total_______
12 bottles of Copper Glo Liquid 13 oz.	Price $14.00	Quantity_____	Total_______
2 bottles Just 'N Time Stain Remover 10 oz.	Price $7.50	Quantity_____	Total_______
6 bottles Just 'N Time Stain Remover 10 oz.	Price $20.00	Quantity_____	Total_______
4 bottles of BKF Lime Remover 16 oz.	Price $7.50	Quantity_____	Total_______
12 bottles of BKF Lime Remover 16 oz.	Price $19.00	Quantity_____	Total_______
6 bottles BKF Cooktop Cleaner 13 oz. ( Shiny Sinks Plus)	Price $11.50	Quantity_____	Total_______
1 Bar Keepers Friend Gift Basket	Price $14.95	Quantity_____	Total_______
1 Bar Keepers Friend Surprise Bargain Box	Price $14.95	Quantity_____	Total_______
4 cans of Bar Keepers Friend Cookware 12 oz. .	Price $7.00	Quantity_____	Total_______
12 cans of Bar Keepers Friend Cookware 12 oz.	Price $18.00	Quantity_____	Total_______
1 bottles of Hexol 16 oz.	Price $6.00	Quantity_____	Total_______
1 Christmas Apron	Price $14.95	Quantity_____	Total_______
2 One Wipes	Price $6.00	Quantity_____	Total_______

Merchandise Total	__________________
shipping and handling (Chart on the back of this form)	__________________
Indiana residents 7% Sales Tax (If applicable):	__________________
Total Amount:	__________________