Name: ___________________________________________________

Address:__________________________________________________

City:____________________________ Province/State:_____________

Country:__________________________________Zip:_____________

Phone #:______________________ Fax #:_______________________

E-mail Address:____________________________________________

I wish to order the following products from you:

Quantity Description of Product Size Unit Price Total                                                                                           Shipping Charges $  ORDER TOTAL                                 Payment via (check one )  (Enclosed) cheque No__________Issuing Bank______Amount_____ Money order _____ ........................C.O.D.____________ I have read and agreed to the Terms and Conditions: ___________________ Initial