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ORDER FORM
PLEASE PRINT A COPY
FILL OUT AND FAX TO 705-327-5281
Payment may be made by Visa, Mastercard, American Express, Cheque or Money Order.
Credit terms available to approved accounts.

PLEASE NOTE: $15.00 HANDLING CHARGE WILL BE ADDED TO ORDERS UNDER $60.00.

Shipping Charges are extra at cost
New York State residents please add Sales Tax. Prices shown are in US Dollars

Name.................................................................Company.............................................................................................

Street Address or Mailing Address...................................................................................................................

City..........................................................................State.................................Zip Code................................

Telephone No.....................................Fax No..................................Email.........................................................

Payment method (circle) ........... Visa.......... Amex...... Cheque.......... P.O. No..................................

Card No...................................................................Security Code.................... Expiry........................

Cardholder's Name........................................................................................................................

Please list items you wish to order
Part No.	Description	Quantity	Unit Price	Total
			TOTAL

Signature......................................................................................
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JANUARY 2018