NSi Industries, LLC - 800.321.5847 - www.nsiindustries.com PROMOTIONAL DATES: June 17 to July 26, 2013 ELIGIBLE PRODUCT LINES ARE: Easy-Wrap ™ Tape, Easy-Twist ™ Wire Connectors, Cable Ties, Miniterms, Polaris ™ Order must contain eligible items that equal or exceed amounts listed below to qualify for a EXXON/MOBILE Gas Card. MINIMUM ORDER CARD VALUE $ 1,500 to1999…… . $ 25 card $ 2,000 to 2,999…. . . $ 50 card $ 3,000 to 3,999…… $ 75 card $ 4,000 + ………… . $ 100 card Cumulative orders are not permitted. FOR NSI USE NSi order number: ______________________ Order amount: ________________________ ISR Signature: ________________________ Order ﬁlled date: ______________________ Just fax or send this form with your order. Your card will come to the addressee within a month of your order, to the address speciﬁed on your remittance. ORDERS CANNOT BE ACCUMULATED TO MAXIMIZE AWARD. Distributor Name: __________________________________ Order P.O. Number: _________________________________ Address: _______________________________________ _____________________________________________ ____________________________________________ Send to Attention of: _______________________________ PROMO CODE: BTB13 __ BTB-CARD-25 . . . . . . . $25 __ BTB-CARD-50 . . . . . . . $50 __ BTB-CARD-75 . . . . . . . . $75 __ BTB-CARD-100 . . . . . . . $100 ENTER # OF CARDS

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Page 1: ELIGIBLE PRODUCT LINES ARE - NSi Industries - Home

NSi Industries, LLC - 800.321.5847 - www.nsiindustries.com

PROMOTIONAL DATES:June 17 to July 26, 2013

ELIGIBLE PRODUCT LINES ARE:Easy-Wrap™ Tape, Easy-Twist™ Wire Connectors,

Cable Ties, Miniterms, Polaris™Order must contain eligible items that

equal or exceed amounts listed below toqualify for a EXXON/MOBILE Gas Card.

MINIMUM ORDER CARD VALUE$1,500 to1999…… . $25 card$2,000 to 2,999…. . . $50 card$3,000 to 3,999……$75 card$4,000+…………. $100 card

Cumulative orders are not permitted.

FOR NSI USE

NSi order number: ______________________

Order amount: ________________________

ISR Signature: ________________________

Order filled date: ______________________

Just fax or send this form with your order. Your card will come to the addressee within a month of your order, to the address specified on your remittance. ORDERS CANNOT BE ACCUMULATED TO MAXIMIZE AWARD.

Distributor Name: __________________________________

Order P.O. Number: _________________________________

Address: _______________________________________

_____________________________________________

____________________________________________

Send to Attention of: _______________________________

PROMO CODE: BTB13

__ BTB-CARD-25 . . . . . . . $25__ BTB-CARD-50 . . . . . . . $50

__ BTB-CARD-75 . . . . . . . . $75__ BTB-CARD-100 . . . . . . . $100

ENTER # OF CARDS