Make check payable to: To order please print this form and mail with  payment.    Date:________________
D & D Chemical, Inc.
2065 Marion Ln.
Kinston, NC 28504
1(252)523-8255

To order online : http://www.ddchem.com/Chimneydraftinducer.htm

Mail to: Ship to: Phone:
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_____________________ _____________________ Email:
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(  )UPS                                      (  ) US Postal Service Credit Card  Name______________________________     (You may fax to 1-252-523-8255)

Card Number: ________________________________         Exp: _____________

Products will be shipped when out of state check have cleared our bank.

Description         Price                   Quantity         Total Cost
6 " Stainless Chimney Inducer         $705.00                   _______          ________
8" Stainless Chimney Inducer         $735.00                   _______          ________
10" Stainless Chimney Inducer         $980.00                   _______          ________
13" Stainless Chimney Inducer         $995.00                   _______          ________
SC-6C,8C Speed Control         $69.50                   _______          ________
Sc-10C,13C Speed Control         $69.50                   _______          ________
    North Carolina Sales Tax 6%          ________
    Shipping & Handling   $15.75 per inducer           __________   
    Total Cost          $ ________