Fluid Film Dealer Order Form

This form is for established Eureka Fluid Film Dealers

When you enter an online order, it goes directly to our warehouse for immediate shipment. This can save time in getting your order out the door.

We have all your payment and shipping information on file. Just enter what you need, and we'll do the rest. Thanks !

Please note: There is no pricing or secure information being transmitted on this form. We will apply dealer pricing to all orders from established Fluid Film dealers.

Company Name
Account # (from previous invoice)
Email Address:
Contact Name:
Telephone #
P.O.# (if used)
AS11 11.75 oz. Aerosol Cans. 12 cans per case
NAS1 Gallons of NAS. 4 Gallons per case
NAS5 5 Gallon Pail of NAS
Spray Gun & Bottle. 4 guns per case.
NAS55 55 Gallon Drum of NAS
Liquid A Gallons. 4 Gallons per case
Liquid A 5 Gallon Pail
Liquid A 55 Gallon Drum
Enter anything you would like to tell, or ask us here: If you'd like an order confirmation sent to you, just enter your fax or email here.