Fax your order to (847) 816-8866 | $35 Standard Shipping Cost for Window Well Covers Sizes 36" x 24" or Smaller! For sizes larger than 36" x 24" there will be an additional shipping surcharge added at time of processing.

Credit Card Information Ship To Information
   

Name as on CC ___________________

Name __________________________

Street __________________________

Street __________________________

City ______________ St ___ Zip_____

City ______________ St ___ Zip_____

Phone (____)____________________

Phone (____)____________________

CC No.__________________________ Expiration Date ____/____ CVC Code ______

Authorizing Signature __________________________

 
 

Width

x

Length

=

Total Sq In

x

Per Sq In

=

Each Cover

 

Cover 1

_____

x

_____

=

_______

x

$0.14

=

$________.___

 

Cover 2

_____

x

_____

=

_______

x

$0.14

=

$________.___

 

Cover 3

_____

x

_____

=

_______

x

$0.14

=

$________.___

 

Cover 4

_____

x

_____

=

_______

x

$0.14

=

$________.___

 

Cover 5

_____

x

_____

=

_______

x

$0.14

=

$________.___

 

Cover 6

_____

x

_____

=

_______

x

$0.14

=

$________.___

 
 

Locks

       

______

x

$20.00

=

$________.___

 

Tabs

       

______

x

$5.00

=

$________.___

 

Reinforcing Angle*

       

______

x

$25.00

=

$________.___

 

* One reinforcing angle is needed for each 12" beyond 36" Width
* One reinforcing angle is needed for each 12" beyond 24" Length

Sub-total

 

 

 

 

 

 

 

 

$________.___

 

Sales tax (if in IL)

   

Sub-total

$______

x

7%

=

$________.___

 

Total Purchase

 

 

 

 

 

 

 

 

$________.___

 

 Notes and Comments: