Print out this Order Form and send it to the Address Below:

Payment by Money Order in U.S. Dollars.
Shipment by U.S. Mail.
Application instructions included with order. ((504)638-0215)

Mail to:

A C Occhipinti
249  Georgetown Dr.
Kenner, LA 70065

Order by (please print)

Name________________

Address______________

City_______________State/Prov.____________________

Zip/Postal Code__________________

Email Address____________________    (optional)

MINIMUM ORDER 10 FEET

____________________________________________________

Dimpletape®       Quantity        Price    Net Total

    Dimpletape®   ________ feet x $4.95 = $_________

shipping and handling: $4.95 = $

                                 Total:   $

Return to HomePage