The Wipe Out! CD Repair Kit comes in a 3/4 ounce quantity, sufficient to repair approximately 40 discs.
It will be shipped to you in a 1 ounce bottle, to allow room to mix by shaking. You will also receive a
non-abrasive polishing cloth and written instructions. Wipe Out! is a simple product you will use to restore
your Music, Data, or Multimedia collections to full playability.

Please fill in this form, and make the appropriate choices below. Once satisfied with your choices, please
print this form with the print command from your browser. Since you will not be submitting this
information over the net, your credit data is totally secure.


 

Quantity

Item

Cost Each

__________

Wipe Out! CD Repair System

$9.99

__________

Wipe Out! CD Repair Two-Pack (2 Systems, 1 S&H Fee)

$19.98

 


Please select from the following shipping options: (check)

 

____                 Basic Shipping and Handling (Within the United States)                            $5.00

____                 International Shipping (Outside United States)                                          $7.00

 

 

Please give us your Shipping Information:

 

Last Name: ___________________________________________________

First Name and Middle Initial: ______________________________________

Street Address:  ________________________________________________

City: _________________________________________________________

State or Province: _______________________________________________

Postal or Zip Code: ______________________________________________
Country: ______________________________________________________

E-mail Address: ________________________________________________

Phone: _______________________________________________________

 


METHOD OF PAYMENT

If you are paying by credit card, you may simply fax this form to the fax number listed below.
Please enter your credit card information below:

Credit Card Type:

___Visa             ___ Mastercard              ___ American Express


Name on Credit Card: (Cardholder name) __________________________________

Address: (Please enter your billing address)_________________________________
____________________________________________________________________

City: _________________________         Zip Code: _____________

Credit Card Number (No spaces or hyphens please): _________________________

Expiration Date: (MM/YY only) ______________________

Signature:___________________________________________(print out, then sign)

If you have completed your order, you may choose print on your browser at this time.
Then please fax this form and your preferred payment to us at:

Esprit Development Corporation
5 Stephen Court
Ringoes, New Jersey 08551 USA

Fax Order Line: (908) 284-0626

Please be sure to include the correct shipping and handling charges to your order.

United States except New Jersey
One Unit $9.99 plus $5.00 S&H or $14.99 total
Two Units $19.98 plus $5.00 S&H or $24.98 total

New Jersey Residents Only:
Please add applicable State Sales Tax to your order.
New Jersey Residents: One Unit $9.99 plus $.60 State Tax plus $5.00 S&H or $15.59 total
Two
Units $19.98 plus $1.20 State Tax plus $5.00 S&H or $26.18 total

International Orders
One Unit $9.99 plus $7.00 S&H or $16.99 total
Two Units $19.98 plus $7.00 S&H or $26.98 total