286 Monteith Ave.
Stratford, Ontario
CANADA N5A 2P8

Fax: 1-519-275-2376  • Phone: 1-519-275-2374
(You may fax or mail this completed form to us. We do not accept orders by telephone. )

ORDER FORM

Product Number

Product Description

Qty.

Unit Price

Total

Office use only

           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
Visa MasterCard #   Sub Total

 

Expiry Date   Handling

 

Signature   Shipping

 

Customer Fax or Phone

 

Taxes

 

Email address   Total

 


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