Poly Glide, Inc. Order Form

1. Fill in the shipping information below.
2. Mark the quantity for the desired product(s).  Use TAB to move to next field.
3. When finished, push the submit button.

The order will be sent to the Poly Glide offices for processing.

You will be contacted by phone or e-mail to confirm the order before your order is shipped.

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Name

Ship To Address

City, State, Zip

Phone Number

P.O. Number

Email Address

Qty.

Description

Cost

40PGX     Poly Glide 40lb.box

 $160.00
20PGX     Poly Glide 20lb.box $84.00
10PGX     Poly Glide 10lb.box $45.00
40WGX   Poly Wind Guard 40lb.box $170.00
20WGX   Poly Wind Guard 20lb.box $89.00
10WGX   Poly Wind Guard 10lb.box $48.00
40NBX    Poly Neutral Beads 40lb.box $184.00
20NBX    Poly Neutral Beads 20lb.box $96.00
10NBX    Poly Neutral Beads 10lb.box $51.00
40WRX   Poly Wind Resister 40lb. box $190.00
20WRX   Poly Wind Resister 20lb. box $99.00
10WRX   Poly Wind Resister 10lb. box $53.00
40MWX  Poly MegaWind 40lb.box $110.00
20MWX  Poly MegaWind 20lb.box $55.00
10MWX  Poly MegaWind 10lb.box $27.50
AZ     Arizona Seal & Glaze 1 gal. $43.00
PTS   Poly Thermo Seal 1 gal. $38.00
PTC   Poly Tri-Coat 1 gal. $48.00
PUG   Poly Ultra Glide 1 gal. $41.00
PCN   Poly Court Neutralizer 1 gal. $19.00
PPS    Poly Power Strip 1 gal. $29.00
PSS    Poly Sure Strip 1 gal. $21.00
USB1 Poly Ultra Spray Buff Treatment 1 gal. $35.00
USB    24 Poly Ultra Spray Buff Treatment 24 oz. $15.00
SS       Speed Spray 8 oz. $14.00
TBA  18" T-Bar Applicator Complete $40.00
NS     Nylfoam Sleeve $15.00
MG     Maintenance Guides N/C

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