ORDER FORM
CONTACT INFORMATION
* To use - You must have an Email Account set up on your computer (ex. Outlook Express) -
if no email on your computer, still click the Print & Email button and you can fax the order
Toll Free to 1-877-524-6500
We will then reply to your Email, confirming receipt of your order.

*Company Name:

required field *

*Contact Name:

E-mail:

*Phone: Fax:

*Shipping Address:

New Customer: Current Customer: Account Code:

Billing Address Is Same As Shipping?

Billing Address:

(if different than shipping)

Payment information on file Will phone with information

Please phone 1(306)652-2112 or fax 1(306)653-4334 with payment details

ITEM # -

Quantity -

Description -

Price

Comments

Type Order Here

Then Click On The
Print & Email Button
At Bottom Of Page

Follow directions
from your printer and
email program