Epo-Grip Order Form
NEWTON SUPPLY COMPANY INC. 
 13953 S.W. 140 STREET .  MIAMI .  FL.  33186 . 
 (305) 235-6503 .  1-800-888-2467 .  FAX (305) 235-7475 

 FURNITURE ORDER FORM

DATE:____________

CUSTOMER INFORMATION:

CONTACT PERSON:______________________________________________

COMPANY NAME:________________________________________________

 BILL TO:     ADDRESS:______________________________________________________

                          CITY:_________________________STATE:____________ZIP:____________

PHONE: (____)______-________        FAX: (____)______-__________

SHIP TO:    ADDRESS:_______________________________________________________

                           CITY:_________________________STATE:____________ZIP:_____________

COMMERCIAL_______           RESIDENTIAL_________

P.O.#_________________ 

PRODUCT       PRICE* QTY

UNIT (CIRCLE WANTED SIZE)
LIQUID FAST SET ________  ________  4 OZ
6 units/Carton		 8 OZ
4 units/Carton		 16 OZ  1 GAL. 
CLEAR PASTE ________  ________  8 OZ  16 OZ  1 QT  1 GAL. 
#30 PASTE ________  ________  8 OZ  16 OZ  1 QT  1 GAL. 
PASTE FILLER ________  ________  8 OZ  16 OZ  1 QT  1 GAL. 
THIN SET/INJECTABLE ________  ________  6 OZ  12 OZ 
SYRINGE & TWO NEEDLES ________  ________         
ULTRA CLEAR COAT ________  ________  12 OZ  24 OZ 
QUICK REPAIR PUTTY ________  ________  12 OZ 
PALETTE KNIFE ________  ________       
*Please call us for pricing at 800-888-2467.