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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: MINIMUM ORDER $150.00 PLUS SHIPPING
Shipping Charges and Taxes are extra.
Prices shown in both US and CANADIAN DOLLARS

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

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

City..........................................................................State/Province.................................Zip/Postal 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......................................................................................

 
UPDATED MAY 2019