15
BISSELL CleanView Order Form
Order Information
Item
Part No.
Part Name
Qty.
x
Unit =
Total
Price
1
32074
Style 7 Drive Belt (2 pack)
______
$2.99
______
______
2
203-1007
Headlight Bulb
______
$1.95
______
______
3
203-1063
Crevice Tool
______
$2.99
______
______
4
203-1083
Dusting Brush
______
$1.70
______
______
5
203-1084
Extension Wand
______
$1.50
______
______
6
203-1036
Vacuum Hose
______
$8.50
______
7
203-2012
Vacuum Hose Clear
(Select Models Only)
______
$9.50
______
______
8
203-1016
Brush Roll
______
$15.95 ______
______
9
203-2013
Power Trak Brush Roll
(Select Models Only)
______
$17.95 ______
______
10
203-2056
Pre-Motor Filter
______
$1.50
______
______
11
203-1009
Post-Motor Filter
______
$2.95
______
______
12
32076
HEPA Media Post-Motor
Filter (Select Models Only)
______
$9.99
______
______
SUB TOTAL
______
Sales tax based on delivery address
Shipping
______
AR, AZ, CA, FL, GA, IL, KS, MA, MD, MI, MN, MO,
NC, NE, NJ, NY, OH, PA, TN, TX, UT and WA
residents add applicable sales tax.
Sales Tax
______
Price applicable in continental United States only
Price subject to change without notice
Order Total
______
Billing Information
Charge:
Mastercard
Enclosed in your envelope
check or money order
Visa
payable to BISSELL Homecare, Inc.
(No cash or stamps please)
American Express
Discover
Telephone ________________________________________________________
Account
Number
(include all digits)
Card
Expires
Month Year
Signature __________________________________
Or visit BISSELL website - www.bissell.com
1
2
Shipping Information
Ship To ____________________________
Address ____________________________
____________________________
City
____________________________
State
____________
Zip____________
3
MAIL REORDER FORM TO:
BISSELL Homecare Inc.
Mail Order Department
PO Box 3606
Grand Rapids MI 49501
OR FAX TO:
1-616-791-7711
Shipping and Handling
.01 to $4.99 = $2.95
$5.00 to $19.99 = $4.95
$20.00 to $99.99 = $7.95
$100.00 to $229.99 = $13.95
$230.00 and up = $25.95
UPS 2nd Day = above shipping $5.75
UPS Next Day = above shipping $19.95
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