Touch-Up Solutions Catalog 9.0 web ver. 22109

Order Form Date: _____/_____/ 20____

PO #: ____________________ Date Required: ______/______/ ______

Is this a Rush?

Sales Rep or Distributor: ______________________________ Sales Order #: SO#_________________

Yes or No

Company Name: ___________________________________________ * All new accounts will have to fill out a Credit Application. If items are needed immediately, please contact Customer Service or order Online.

Bill To Address

Ship To Address

Address: _______________________________

Address: _______________________________

City: _____________ State: ____ Zip: _______

City: _____________ State: ____ Zip: _______

Attention: ______________________________

Attention: ______________________________

Phone #: (______)________________________

Phone #: (______)________________________

Fax #: (________)________________________

Fax #: (____)______________________

Email: ______________@__________________

Email: ______________@__________________

Ship to Billing Address

QTY

EA / CS

Item #

Description

Price

Rewards Coupon Code

Note: _____________________________________ Signature: _________________ Date: _____/_____/ _______ Pricing: Please see our current Price List. Our prices are subject to change without notice. All prices are F.O.B. Maiden, NC (except where noted on Sales Order). All prices are in U.S. Dollars.

Minimums: We have a NO minimum order policy.

Back Orders: In the event that any item is out of stock we will notify you the same day or the next day after your order ships.

Shipping: We ship with UPS or Federal Express Ground in 1 to 3 business days.

Return Policy: Errors must be reported in 10 business days or 60 days to return with 25% restock fee.

Open Account Payment Terms: Open Accounts are Net 30 days from the date of shipment. We accept MASTERCARD®, VISA® and American Express® credit cards.

New Account Payment Terms: Please contact Customer Service to establish credit ( 1 to 2 weeks wait ) We also accept MASTERCARD®, VISA® and American Express® credit cards.

Hours: Our Corporate Office / Customer Service opens at 8am – 5pm ( East Coast ) Monday - Friday.

Mailing: PO Box 368 Maiden NC 28650 USA

Ship To: 4372 Providence Mill Rd 28650 USA

Website: www.touchupsolutions.com

E-mail: wecare@touchupsolutions.com

Telephone #: 828.428.9094 / Toll Free: 1.877.346.4747

Please fax your order to: 828.428.9970 rev. 1/25/09 (tp)

Thank YOU for your order!!!!

Po Box 368 Maiden, NC 28650 Tel: 828-428-9094 Fax: 828-428-9970

Credit Application

Company Name: ____________________________________________ A/P Contact: ________________________________ Address: _______________________________________ City: ______________________ State: _______ Zip: ____________ Phone #: _____________________ Fax #: ___________________ Email: _________________ D & B #: _________________ Years in Business: ______ Year Started: _____ Form of Business: ___ Sole Proprietor ___ Partnership ____ LLC ___ LLP * Form of Business: ___ Sole Proprietor ___ Partnership ____ LLC ___ LLP *State of Incorporation ____________ Federal ID #: ____________________ Tax Exempt: ___ Yes ___ No (If yes attach exempt form) Annual Sales: ____________________________________ Number of Employees: ____________

Owners / Officers / Partners Name: _______________________________________ Title: _________________________ Email: _______________________ Name: _______________________________________ Title: _________________________ Email: _______________________ Name: _______________________________________ Title: _________________________ Email: _______________________

Bank References 1. Bank Name: ______________________________ Contact: ________________________ Contact Phone #: ______________ Address: _________________________________________________________________________________________________ Account #: ______________________ Contact Phone #: ______________________ Contact Fax #: ______________________ 2. Bank Name: ____________________________ Contact: ________________________ Contact Phone #: ________________ Address: _________________________________________________________________________________________________ Account #: ______________________ Contact Phone #: ______________________ Contact Fax #: ______________________

Trade References 1. Company Name: ___________________________Contact: ________________________ Contact Phone #: _____________ Address: _________________________________________________________________________________________________ Account #: ______________________ Contact Phone #: ______________________ Contact Fax #: ______________________ 2. Company Name: ____________________________Contact: ________________________ Contact Phone #: _____________ Address: _________________________________________________________________________________________________ Account #: ______________________ Contact Phone #: ______________________ Contact Fax #: ______________________ 3. Company Name: ____________________________Contact: ________________________ Contact Phone #: _____________ Address: _________________________________________________________________________________________________ Account #: ______________________ Contact Phone #: ______________________ Contact Fax #: ______________________

Authorization to Release Information Date: ___________ Firm Name: _________________ Address: __________________________________ Authorized By: ___________________________ Name: ____________________ Title: _______________ rev. 2/19/09 (tp)