Lambert’s Home Services, LLC

www.diywatertesting.com

Please Print and Complete

Name: ______________________________________________________________________________________________________

Address: ____________________________________________________________________________________________________

City: _______________________________________ State:_______ Zip:__________________ _

Daytime Phone _____________________________________________________

Email Address _____________________________________________________

Ship to address (if different from above)

Name:_______________________________________________________________________________________________________

Address:_____________________________________________________________________________________________________

City:________________________________________ State:_______ Zip:___________________


Method of payment:
[_] Check or money order enclosed: Payable to Lambert’s Home Services, LLC
[_] VISA
[_] MasterCard
[_] Discover

Credit Card Number:__________________________________Exp.Date___________ CVC ___________ IF CORPORATE CARD WHAT IS YOUR CODE?___________________________

Your Signature:______________________________________Date:_______________

For Mail-In Orders send to:
Lambert’s Home Services, LLC   -    P. O. BOX 328 Bristol, IN  46507-0328
Order by Fax:     (574) 966-1353
Order by Phone: (574) 596-6124
Order by email: orders@lambertshomeservices.com

___________________________________________________________________________________________

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Please add up your order and fill in the amounts below:

Merchandise Subtotal ______________________

Shipping and Handling ___________________

(IN Residents add 6% sales tax)___________

Order Total ____________________________