Nealey Tire Repair Kit Traditional Order Form

	Quantity	Price (US Funds)
MINI Repair Kit (2 & 4 Ply Tires) - short tool & 10 (7 inch) repairs		$11.95
--- Refill kit 10 (7 inch) repairs		$9.95
--- Refill kit 20 (7 inch) repairs		$14.95
STANDARD Repair Kit (6 Ply & Larger Tires) - long tool & 10 (14 inch) repairs		$15.95
--- Refill kit 10 (14 inch) repairs		$11.95
Best Buy! DELUXE Repair Kit (6 Ply & Larger Tires) - long tool & 20 (14 inch) repairs		$21.95
--- Refill kit 20 (14 inch) repairs		$17.95
Add $1.25 per kit shipping and handling (maximum $5.00 per order)
Sales tax is only collected from Iowa residents

Billing and Shipping Information:
Name
Address
City	State/Prov Alabama Alberta Alaska Arizona Arkansas British Columbia California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland and Labrador North Carolina North Dakota Northwest Territories Nova Scotia Nunavut Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Island Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Yukon Zip
Phone	(use this format: 515-555-5555)
Email

Nealey Company, 14409 Buena Vista Drive, Urbandale, Iowa 50323 | 515-987-0000 | 800-289-9781 | nealey@tirerepairkit.com