Radon Detek

Order Form

item qty price total

2 day canister _________ x $16.50ea = _________

3-5 day canister _________ x $19.00ea = _________

long term detector (over 90 days) _________ x $25.00ea = _________

radon water kit _________ x $25.00ea = _________

subtotal _________ _________

Add 6% PA sales tax + _________

postage paid (use subtotal) _________ x $2.61 ea = + _________

TOTAL _________

Please enter the following:

NAME: ____________________________________

ADDRESS: ____________________________________

____________________________________

CREDIT CARD #: discover, visa, or master card

____________________________________

expiration date: ___________ 3digit security code _____

SIGNATURE: _____________________________________

contact info: phone number or email ________________________

Fax or call 888-657-7032 or 717-657-7032 to order.

Or send form with check to:

TCS INDUSTRIES INC

4326 CRESTVIEW RD

HARRISBURG PA 17112

no sales outside U.S. or in N.J.