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Privacy and Security Policy                             Conditions of Use (Disclaimer)
  Phone: 519-942-0898 or 613-692-3577   Country code (001)
 Please type in information, print (high quality), and FAX to:  519-942-3422 or  mail to:
**Hand writing Form is available by clicking here.**

Date:  
Name:
Address (including Country):

Daytime Telephone: 
E-mail address: 

Item#






 Quantity






 Item Description






 Price






 Total
Canadian residents please add GST /HST
Ontario residents GST& PST		 shipping
(if listed)
Total
If not listed on our site, shipping will be calculated after your order request is received.
*Canadian and International Orders use $Canadian Dollar Prices.  
U.S. Customers only use $U.S. Dollar Prices. 

Please ship my order:   UPS     Surface Mail

Payment:   Cheque/ Money Order   VISA     Mastercard
(allow 30 days for Personal Cheques to clear bank)

Card Number:
 Expiry (Mo/Yr) -                                                               _________________

Additional Comments, Instructions or Product Suggestions: