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:
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