Use the form below to order Rubbn'Repair products. You will be contacted by CRG Industries to confirm your order, obtain payment information, and be given a lead time and shipping estimate for your order.

Domestic orders of up to 20 patch panels will be sent via US Postal Service. To get a discount on orders of 20 or more panels, for overseas shipping prices, or for alternative shipping methods, please call.

Distributor inquiries welcome — see option below in the form. If you wish to be a distributor, please describe your distribution market. Volume discounts available on all patch materials. Please call. * = required field.

Contact Information:
Individual's Name:		*
Company Name:
Apt/Suite Number and Street Address:		*
City:		*  State:   Zip:
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Phone Number (include area code):		*
Email address:		*
Select Method of Payment (required, you will be contacted for payment):		For all domestic orders or international orders of $100.00 US or less:   Credit Card (VISA, MC, AmEx, Discover)   Pay Pal (Payee - rigginsjk@crgrp.net)   Company Check (US only with approved Purchase Order)   Electronic Funds Transfer For international orders over $1,000.00 US:   International Letter of Credit International customers, please provide your VAT (Value Added Tax) number for exporting/importing:
Order:
Patch Product		Unit Qty	Select a Product or Size
	Rubbn'Repair™ automotive repair patch material	Qty: Length in inches:	2-inch stock width	Price: 375¢ per square inch, or $54.00 per square foot
			6-inch stock width
			12-inch stock width
			18-inch stock width
I'm interested in becoming a distributor, please send me more information:
Special Needs or Comments:
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