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Order Form

Please fill out the form, print and fax to us at (905) 470-7166

Last Name
First Name
Address

Tel. Number Fax Number
E-mail

Ship To: same as the above or

Last Name
First Name
Address

Tel. Number

Order Information:

Brand Name Product Name Colour Quantity Price
Sub-total

Sales taxes and Shipping charge will be added to total charges where applicable.

Payment: VISA Master Card Amex
Card Number
Expiry Date
Name on Card

Signature__________________     (Please print form, sign & fax to 905-470-7166)