Poly Glide, Inc. Order Form 
           (Please call 800-921-1722 to place your order)

1. Fill in the shipping information below.
2. Mark the quantity for the desired product(s).  Use TAB to move  to next field.
3. When finished, push the Submit button.

The order will be sent to the PolyGlide offices for processing.

You will be contacted by phone or e-mail to confirm the order before your order is shipped.


Now Accepting:

   

Credit card orders can only be taken by phone.  Please call (800) 921-1722.
 

Use [TAB] to move between fields.  DON'T press [ENTER] until finished.

Company Name
Contact Name
Ship To Address
City, State, Zip
Phone Number
P.O. Number
Email Address

Qty.

Description

Cost

40PGX       Poly Glide 40lbs                           $205.00
20PGX       Poly Glide 20lbs $115.00
10PGX       Poly Glide. 10lbs $64.00
40WGX      Poly Wind Guard 40lbs $215.00
20WGX      Poly Wind Guard 20lbs $120.00
10WGX      Poly Wind Guard 10lbs $65.00
40NBX      Poly Neutral Beads 40lbs $240.00
20NBX      Poly Neutral Beads 20lbs $126.00
10NBX      Poly Neutral Beads 10lbs $68.00
40WRX     Poly Wind Resister 40lbs $245.00
20WRX     Poly Wind Resister 20lbs $135.00
10WRX     Poly Wind Resister 10lbs $78.00
40MWX    Poly MegaWind 40lbs $120.00
20MWX    Poly MegaWind 20lbs $70.00
10MWX    Poly MegaWind 10lbs $42.00
40PB           Poly Blaze 40lbs 230.00
20PB         Poly Blaze 20lbs 125.00
10PB         Poly Blaze 10lbs 75.00
40PEW      Poly Eastern Wind 40lbs Discont.
20PEW      Poly Eastern Wind 20lbs Discont.
10PEW      Poly Eastern Wind 10lbs Discont.
40PEM      Poly Eastern Mix 40lbs 155.00
20PEM      Poly Eastern Mix 20lb. box 80.00
10PEM        Poly Eastern Mix 10lbs 44.00
AZ             1 gal. Arizona Seal & Glaze $58.00
PTS           1 gal. Poly Thermo Seal $50.00
PTC           1 gal. Poly Tri-Coat $60.00
PUG          1 gal. Poly Ultra Glide $50.00
PCN          1 gal.  Poly Court Neutralizer $32.00
PPS           1 gal. Poly Power Strip $38.00
PSS           1 gal. Poly Sure Strip $30.00
USB1        1 gal. Poly Ultra Spray Buff $68.00
USB32      32 oz. Poly Ultra Spray Buff  $38.00
SS             Speed Spray 8 oz. $22.00
TBA         18" T-Bar Applicator Complete $57.00
NS            Nylfoam Sleeve $22.00
MG          Maintenance Guides N/C
MFS36    36" Microfiber Wet Mop Set $100.00
MFD36   36" Microfiber Dust Mop  $25.00

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