-
PRODUCT ORDER FORM - Printout:
Note - this is not a PDF.
Once printed you can email or fax (24/7) us this page once it is filled out.

EMAIL:  [email protected]
FAX:  450-688-9565

NAME:

__________________________________________________      -       _________________________________________
First Name - Print                                                                  Middle Name or Initial - Print

___________________________________________________ 
Last Name - Print                                                          -      __________________________________________
                                                                                             Full Name - Signature


CONTACT INFORMATION:

Email:  ____________________________________________
Contact Number (Area Code + Phone Number):  ____________________________


BILLING ADDRESS:

___________________________________________________________________________
Street Address

___________________________________________________________________________
Street Address Line 2

___________________________________________________________________________
City

___________________________________________________________________________
State / Province

___________________________________________________________________________
Postal / Zip Code:

 __________________________________________________________________________
Country


ADDITIONAL REQUEST:

_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________

PRODUCT CODE + QUANTITY:

1 - PRODUCT or PRODUCT CODE:   ____________________________________________   - QUANTITY:  _____   PRICE:   C$__________

2 - PRODUCT or PRODUCT CODE:   ____________________________________________   - QUANTITY:   _____  PRICE:  C$ __________

3 - PRODUCT or PRODUCT CODE:   ____________________________________________   - QUANTITY:   _____  PRICE:   C$__________

4 - PRODUCT or PRODUCT CODE:   ____________________________________________   - QUANTITY:   _____   PRICE:  C$__________

5 - PRODUCT or PRODUCT CODE:   ____________________________________________   - QUANTITY:   _____   PRICE: C$__________

6 - PRODUCT or PRODUCT CODE:   ____________________________________________   - QUANTITY:   _____   PRICE: C$ __________

7 - PRODUCT or PRODUCT CODE:   ___________________________________________     - QUANTITY:  _____   PRICE: C$__________

8 - PRODUCT or PRODUCT CODE:   ____________________________________________   - QUANTITY:   _____   PRICE:  C$__________

SUB- TOTAL:   _____________________________________________________________________________________________:  C$__________

SHIPPING:
Canada-Wide:  C$10.00 - _________________________________________________________________________________:  C$___________
USA - Regular rates apply                                                                                                                                 :  C$___________
International - Regular rates apply                                                                                                                    :  C$___________

TAXES (Canada only) - GST-HST (not applicable outside Canada) ____________________________________________:  C$___________

TOTAL AMOUNT:  _________________________________________________________________________________________:  C$___________



All prices in Canadian $ (dollars).

Orders can be paid through Paypal (online).  Safest way to pay, accepts most credit cards, and you do not need to sign up for an account.

Cheque - Canada only (we do not accept cheques from the USA or International locations):
You can pay by Certified Cheque and/or Personal Cheque preprinted wih your name, address, and your Canadian Banking Instution.

Money Order - Canada:  You can pay with any Money Order issued through Canada Post or you bank.
Money Order - USA:  You can pay with an International Money Order (cashable in Canadian Funds) through your postal or banking instution.