Please provide the following ordering information:                                                           

QTY		CURB PUMP HOSES
		5/8" x 9'6" Hose
		5/8" x 10'6" Hose
		5/8" x 8" Whip Hose

	NOZZLES, SWIVELS, AND BREAKAWAYS
	RI 11AP Black Nozzle
	RI 11A Green Nozzle
	RI 11A Yellow Nozzle
	RI 3/4" Swivel
	HU 2273 Single Use Breakaway
	HU 3360 Reconnectable Breakaway
	Black Capper
	Yellow Capper
	Green Capper

	FILTERS
	Wayne Ovation Gasoline
	Wayne Ovation E-85
	Wayne Ovation Diesel
	Tokheim B Gasoline
	Tokheim B E-85
	Tokheim B Diesel
	Tokheim C Gasoline
	Tokheim C E-85
	Tokheim C Diesel

	Gilbarco Gasoline
	Gilbarco E-85
	Gilbarco Diesel

	PAPER
	Wayne Ovation
	Gilbarco Crind
	Tokheim DPT-B
	Tokheim Insight
	Ruby Thermal
	Ruby Non-Thermal
	Ruby Journal Thermal
	Ruby Journal Non-Thermal
	Ruby Ribbon

	Veeder Root Tank Monitor
	Gilbarco Tank Monitor
	Red Jacket Tank Monitor

	MISC.
	Gasolia Soft Set (4 oz.)
	Gasolia Soft Set (8 oz.)
	Sar-Gel
	OPW Fill Cap
	3/8" x 25' Air Hose
	Milton Air Chuck
	Tank Stick

 

	Customer Information:
* Store #
* Name

* Phone #

	Shipping Information:
* Street Address
Address (cont.)
* City
* State/Province
* Zip/Postal Code

Any additional questions or needs?