Click on the "Print This Page" text link at bottom of page to print out this form which can then be mailed in with your details and payment.
 Bill To: Name/Shipping Address: |
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Ship To: Name/Shipping Address: |
| __________________________ |
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____________________________ |
| __________________________ |
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____________________________ |
| __________________________ |
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____________________________ |
| Phone #: ( _____) - _________________________ |
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| Cheque enclosed Y | N (will be held until cleared) |
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| VISA #: _________________________________ |
Name on Card: ______________________________ |
| MasterCard#: ______________________________ |
Expiry Date: _____________________ |
| AMEX #: ________________________________ |
Signature: ________________________________ |
| Shipping and Handling are at cost. If you would like your items sent by courier please indicate below. We generally use UPS. |
| Please send my item by courier _________________________________. |
