| Please Print & Fax To: 613-738-7270 | ||||
| Item | Product No. | Qty | Price @ | Ext. Price |
| 1 | 1 | 1 | 1 | 1 |
| 2 | 1 | 1 1 | 1 | 1 |
| 3 | 1 | 1 | 1 | 1 |
| 4 | 1 | 1 | 1 | 1 |
| 5 | 1 | 1 | 1 | 1 |
| 6 | 1 | 1 | 1 | 1 |
| 7 | 1 | 1 | 1 | 1 |
| 8 | 1 | 1 | 1 | 1 |
| 9 | 1 | 1 | 1 | 1 |
| 10 | 1 | 1 | 1 | 1 |
| A: Total Before Tax | 1 | |||
| B: Shipping Charge | 1 | |||
| C: Total A + B | 1 | |||
| D: GST 5% of C | 1 | |||
| (ON. Residence Only) E: PST 8% of C | 1 | |||
| (NB, NS, NFLD, PEI, Residence Only) F: HST 13% of C | 1 | |||
| No Taxes on International Orders | ------------- | |||
| Total: | 1 | |||
Items A, B, C, D, E, F are optional we will fill in and return via fax for your confirmation
| Name: | Company: | |
| Address: | Prov/State | |
| City: | PC/Zip | |
| Tel: | Fax: | |
| Visa ______ Mastercard ______ Amex _______ | Card No: | |
| Name On Card: | Exp Date: | |
| Card Holder Signature: | ||
| ORDER COMFIRMATION | |
| Date: | Order Total: |
| Please Charge My Credit Card For The Amount Above: Yes __________ No ___________ | |
| Signed: | |