Translation: Francais Deutsch Espanol Italiano Portugese Japanese Korean Chinese English Privacy and Security Policy Conditions of Use (Disclaimer)

***IMPORTANT: PRINT, FILL OUT, AND FAX, or MAIL THIS ORDER FORM***

The Discriminating General
27 Auriga Drive - Unit 38
Ottawa, ON
K4M 1E4

CANADA


Phone: 613-692-6947 FAX: 613-317-7574 Country Code (001)

DATE:_____________________

Name: __________________________________________________________________________

Address: ________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

_________________________________ Country:_____________________________________

Daytime Phone: ______________________ e-mail Address:______________________________
(We need a phone number no matter what country you live in. E-mail address is
for sending your shipment tracking information.)

Item #

Quantity

Item Description

Price for One

Total Price


Shipping

(for Canada residents only) GST

(for Ontario residents only) PST

Total

Please Ship my order: United Parcel Service (UPS Courier) Surface Mail

Payment: Cheque/"International" Money Order Please Charge my: VISA Mastercard
(Personal Cheques allow 30 days to clear bank)

Expiry: - Security Code(Back of Card)

______________________________


ONLY U.S. CUSTOMERS USE U.S. DOLLAR PRICES. CANADIAN AND OTHER NATIONS PROCESSED IN CANADIAN DOLLARS.

Additional Information: