Refill order form

Greenwood Equine Equipment

Refill Order Form - Please Print & Fax to 816-537-4213

Billing Address:	Ship To address or (Same as billing address)
Name:	Name:
Address:	Address:
City:	City:
State:	State:
Zip Code:	Zip Code:
Telephone:	Telephone:
E-Mail:	E-Mail:

Quantity	Description	Unit Price	Total
	64 oz. Permethrin/32 oz. PBO - 55 gallon system fill	$144.95
	32 oz. Permethrin/32 oz. PBO - 30 gallon system fill	$ 85.95
	64 oz. Riptide 5% Pyrethrin/25% PBO - makes 1- 55 gal. fill or 2 - 30 gal. system fills	$144.95
	32 oz. "Evergreen" 6% Pyrethrin/PBO order 1 for 30 gal. or 2 for 55 gallon system	$109.00
	Gallon "Vampyre" 3% Pyrethrin - 55 gallon system fill	$212.95
	64 oz. CPC-128 All Natural insect control - 55 gallon system	$172.00
	32oz. CPC-128 All Natural insect control - 30 gallon system	$94.95
	Odor Mist Odor Control - Quart	$24.95

(Prices shown do not include UPS charges) Total Order $______________________

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Expiration Date _____________________________________________