Bug-it™Permanent Glass Etching System

ORDER FORMRegulations: Current U.S. safety glazing regulations require that all laminated glass be permanently etched by the glass manufacturer or installer. Bug-it™ Permanent Glass Etching System is a customized solution that meets all safety glazing labeling regulations.

Each Kit includes: 1 set of 50 stencils1/4 oz. of etching cream5 reusable brushes10 disposable swabs

Pricing: 1-2 Kits $67.00 per Kit3-5 Kits $60.00 per Kit 6-10 Kits $54.00 per Kit11-20 Kits $50.00 per Kit21+ Kits $47.00 per Kit

Logos or Graphics: Standard customized Bug-it™ stencils are produced using text only with no set-up charge. If you require a graphic such as a company logo, UL listing, etc., there is a one-time $25.00 artwork set-up charge for each different stencil.

Stencils: Qty. Price Total1 Kit - Laminated ____ x _______ = __________1 Kit - Auto - AS1 ____ x _______ = __________1 Kit - Auto - AS2 ____ x _______ = __________1 Kit - Auto - AS3 ____ x _______ = __________1 Kit - Fire-Rated ____ x _______ = __________1 Kit - Safety-Backed Mirror ____ x _______ = __________1 Kit - Other ____ x _______ = __________

Logo or Graphic Artwork:One-Time Set-Up Charge ____ x _______ = __________

Additional Supplies: 1/4 oz. Etching Cream ____ x _______ = __________1/2 oz. Etching Cream ____ x _______ = __________1 oz. Etching Cream ____ x _______ = __________5 Brushes/10 Swabs ____ x _______ = __________10 Brushes ____ x _______ = __________20 Swabs ____ x _______ = __________

Shipping:Expedited Shipping (USPS or UPS actual charges) __________U.S. Shipping & Handling (Canada - $21.50) __________

Total: __________

Please write the quantity of each type of kit in the space provided below:

Payment Information:Method of Payment: Amex MC Visa Discover

Account #: ___________________________________________

Name on Card: _______________________________________

Exp. Date: _____________CVV#: ______ Billing Zip: _________

P.O. Number (if required) _______________________________

Billing Information:

Company Name: _____________________________________

Ordered By: _________________________________________

Address: ___________________________________________

City: _______________________ State: ____ Zip: __________

Telephone # _________________ Fax # ___________________

Email Address: _______________________________________

$25.00

$ 5.00

$ 7.50$ 10.00

$ 5.00$ 3.00

$ 4.00

$ 8.00

Shipping Information: (if different from Billing Information)

Company Name: _____________________________________

Ordered By: _________________________________________

Address: ___________________________________________

City: _______________________ State: ____ Zip: __________

Telephone # _________________ Fax # ___________________

Email Address: _______________________________________

Bug-it.com 1507 NE 4th St., McMinnville, OR 97128 Phone: 714-893-2602 Fax: 888-383-2003 orders@bug-it.com

Please provide the text for “bug” exactly as you want it to read:

Please include my company name on stencil: Yes No

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