Product Order Form Diesel Check Sulfur Test Kit 10 Pack Part Number 20-072 Prices $195.00 Quantity Diesel Check Sulfur Test Kit 5 Pack Part Number 20-075 Prices $125.00 Quantity Diesel Check Hydroperoxide Test Kit 10 Pack Part Number 20-076 Prices $195.00 Quantity Diesel Check Hydroperoxide Test Kit 5 Pack Part Number 20-077 Prices $125.00 Quantity Diesel Check Bio Diesel Test Kit 10 Pack Part Number 20-080 Prices $195.00 Quantity Diesel Check Bio Diesel Test Kit 5 Pack Part Number 20-079 Prices $125.00 Quantity OAK Kit Part Number 20-051 Prices $624.00 (25 samples) Details OAK kits include bottles, labels, ID forms, mailers and ANALYSIS of 25 samples for any type system. Quantity Prepaid Analysis Part Number 21-016 Prices Call for a quote Details Analysis purchased in any other quantity can be purchased as Prepaid Analysis. Prepaid volume discounts are as follows: For the prepayment of 25-49 sample analysis kits, a 15% discount will apply. For the prepayment of 50-99 sample analysis kits, a 30% discount will apply. For the prepayment of 99-250 sample analysis kits, a 40% discount will apply. Sampling kits, including bottles, labels, ID forms, and mailers are supplied at no additional charge when prepaid analysis is purchased. All other sampling supplies will be charged list price. Call for a quotation on Prepaid Analysis - 800-HERGUTH (437-4884) Quantity Fuel Analysis Kit Part Number 20-045 Prices $ 5.75 Details Kit includes a 16 ounce bottle, ID Form, Fuel Labels, and #5 mailer for the taking and return of a fuel sample. (Diesel fuel with a flash below 140C requires special shipping documents.) Quantity 4 oz Clear Ribbed (Ultra Clean) Part Number 20-003 Prices $1.75 Details Typically used for particle counting. Quantity Vampire Pump, Small Part Number 20-008 Prices $31.50 Details Used for extraction of oil samples from equipment. Quantity 100’ Roll Pump Tubing Part Number 20-013 Prices $7.35 Details Used with 20-008 for extraction of samples. Quantity Canister Mailers Part Number 20-036 Prices $1.58 Details Mailing option for return samples. Quantity Wide Mouth Grease, 16 oz. Part Number 20-002 Prices $2.88 Details Larger mouth allows for grease sampling. Quantity Foam Mailers, Small Part Number 20-010 Prices $0.37 Details Allows for return shipping of up to three samples. Quantity Foam Mailers, Large Part Number 20-011 Prices $0.90 Details Allows for return shipping of up to ten samples. Quantity Shipping to: Attention* Company* Address* City* State* Zip* Phone* Fax* Email Address* Payment Options Purchase Order Number  Check or Money Order Please send this form along with your payment to: 101 Corporate Place Vallejo, CA 94590 Credit Card (Call for credit card information) Card Type Select One Visa Master Card American Express Card Number Expiration Date Name on Card Billing Information - if paying by credit card (Check if same as Shipping Information) Billing Information Name* Company* Address* City* State* Zip* Phone* Date shipment is required* Ship Via Please Select Ground Overnight 2nd Day 3rd Day Address is Select One Business Residential   *Shipping charges will be prepay and added to the order total.

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