Your Name:__________________________________________

Shipping Address:___________________________________________
(No PO Box, please)

City:__________________________State:_____Zipcode:_________

Phone (days):____________________________

Phone (eves):____________________________

Credit Card #:____________________________Exp. Date:_________
(MasterCard, Visa or Discover only, please)

Signature:______________________________________________
ID #                        Rep's Name:

Please send a free Fuller Brush Master Catalog.  __Yes   __No

Item No. Qty: Description: Price ea. Total
         
         
         
         
         
         
         
         
         
         
Handling Charge:  $6.95
flat fee
Sales Tax Policy:    Since we have a business presence in all states, we are required by law to collect sales tax for every state.  Need help finding your area's sales tax?   Just call us at: 1-800-522-0499.
Merchandise total  
Handling from chart  
Merchandise Subtotal  
Sales tax on subtotal  
Total Amount Due  

Make checks payable to:  The Fuller Brush Company
                      PO Box 1247
                                             Great Bend, KS 67530-1247