hydration technologies by payableondeath

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									         HYDRATION TECHNOLOGIES INC. PRODUCT ORDER FORM

Please circle the item price you are buying from {Government Price or Retail Price (MSRP)},
enter the quantity of the item needed under # and enter the total for that item multiplied by the
quantity. Please call for a shipping quote as it will be added into the price once we receive your
order form.

Code         Product              Components                          Govt.    MSRP      #     Total
                                  X-Pack / ten 2-oz syrup bottles
XPG          X-Pack                                                   $44.40    $64.00
                                  / dye tabs
                                  Ten 2-oz syrup bottles and dye
XPRSG        X-pack Resupply                                          $17.00    $24.50
                                  tabs
                                  LifePack / six 2-oz syrup
LPG          LifePack                                                 $23.20    $39.95
                                  bottles
LPGRS        LifePack Resupply    Six 2-oz syrup bottles               $9.90    $17.50

                                  Bladder / Filter / Bite tube /
                                  Slider / Ten 120-ml syrup
                                  pouches / instructions / CD
HWERG        Expedition                                              $199.00   $230.00
                                  Cleaning kit-bulb pump, 2
                                  bottles preservative solution, 2
                                  cleaning tablets. fold-a-cup
                                  Bladder / Slider / Bite Tube /
HWER001G     Expedition Bladder                                       $79.00    $91.50
                                  Instructions / CD
                                  Filter / Cleaning kit (bulb
                                  pump, 2 bottles preservative
             Expedition Filter
HWER002G                          solution, 2 cleaning tables,       $140.00   $162.00
             Kit
                                  fold-a-cup) / ten 120-ml syrup
                                  pouches / instructions
                                  Ten 120-ml syrup pouches / 2
             Expedition
HWERSG                            bottles preservative solution /     $31.00    $36.00
             Resupply Kit
                                  2 cleaning tablets
                                  One Stinger backpack. No
HWERBPS      Stinger Backpack     pockets. Hole for clean water       $30.00    $34.50
                                  cap.
             Tactical Tailor      One Backpack from Tactical
HWERBPTT                                                              $35.00    $39.50
             Backpack             Tailor. Large pocket.
             Expedition
                                  Replacement Expedition slide
RSC          Replacement Slide                                         $5.00     $6.00
                                  closure and strap/buckle.
             Closure

RBT          Bite Tube            Replacement Bite Tube               $15.00    $17.50

                                  Replacement Bulb Pump
RBP          Bulb Pump            (works for both the Hydrowell        $7.50    $10.00
                                  or the Expedition)

                                                                           Continued on next page……
Code          Product               Components                          Govt.    MSRP      #    Total
                                    1 can with tray attached and
                                    filter element installed / 1 can
                                    for clean drink / drink feed
                                    tube / wrench / twenty 410-ml
HWWCRG2       HydroWell 2                                              $287.00   $344.40
                                    syrup pouches / cleaning kit
                                    (bulb pump, flush bag, 2
                                    bottles preservative solution) /
                                    instructions / CD.
                                    1 can with tray attached and
                                    filter element installed / drink
                                    feed tube / wrench / twenty
HWWCRG1       HydroWell 1           410-ml syrup pouches /             $275.00   $330.00
                                    cleaning kit (bulb pump, flush
                                    bag, 2 bottles preservative
                                    solution) / instructions / CD.
                                    Filter element attached to cap /
                                    tray assembly / drink feed tube
                                    / wrench / twenty 410-ml
              HydroWell
HWFCRG0                             syrup pouches / cleaning kit       $260.00   $312.00
              Filter System
                                    (bulb pump, flush bag, 2
                                    bottles preservative solution) /
                                    instructions / CD.
              HydroWell
HWWCR1G                             Filter attached to cap             $200.00   $240.00
              Filter Replacement
                                    Twenty 410-ml syrup pouches
              HydroWell
HWWCRSG                             / bulb pump / flush bag / 2         $75.50    $90.60
              Resupply Kit
                                    bottles preservative solution
              HydroWell             Tubing and cap to connect two
HWWCR3G                                                                  $7.00     $8.40
              Drink Connections     cans
              HydroWell
HWWCR4G       Syrup                 Tray assembly / wrench              $14.25    $17.10
              Feed System
                                    SeaPack / five 4-oz syrup
SPG           SeaPack                                                   $48.00    $99.95
                                    bottles / dry bag

SPGRS         SeaPack Resupply      Five 4-oz syrup bottles             $19.20    $38.00

All orders are tax-free. No sales tax in Oregon.                                    Subtotal:
Shipping will be automatically calculated into your total when we
receive your order.
                                                                                   Shipping:
If you prefer, you can call HTI for a shipping quote today -
(541)917-3335. Please call for a shipping quote in advance of                          Total:
sending a check or money order payment.

Please contact HTI with any questions at (541)917-3335 or at our toll free number at
(866)282-5353.

Order Online – You can order online 24 hours a day at www.htiwater.com.
For fax, e-mail and mail-in orders, fill out the info below:

I will be paying by (circle one):         Credit Card            Check            Money Order

Type of Credit Card (circle one):
       Visa           Mastercard                 American Express                 Discover

Credit Card Number:                 _________________________________

Expiration Date:                    __________

Name on Card:                       _________________________________

Shipping address and phone number:                  Billing Address (if different from shipping):

___________________________                         ___________________________
Name                                                Name
___________________________                         ___________________________
Street Address                                      Street Address
___________________________                         ___________________________
City             State              Zip             City             State           Zip
___________________________
Phone

Order by Phone, Fax, Mail or E-mail

For phone, fax, mail and e-mail orders we accept Visa, Mastercard, American Express, Discover
and checks or money orders.

For phone orders, call (541)917-3335 or our toll free number (866)282-5353.

For fax orders, call (541)917-3345.

E-mail orders: Fill out the form in MS Word and send it to K.Paschke@HydrationTech.com

Please Note: If you have not called for a shipping quote, shipping will be automatically added to
your order total.

For checks and money orders, please contact us for a shipping quote before sending the
payment. Please make checks / money orders payable to Hydration Technologies Inc.
If you would like to send a check or money order, we will ship the order once payment is
received and cleared.

To mail in your order form, please send to:

Hydration Technologies, Inc.
Attn: Product Order Form
PO Box 1027
Albany, OR 97321

								
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