Ship To:

Company Name:_______________________________________________ Customer Code__________

Contact Name:______________________________________________________________________

Address:__________________________________________________________________________

City:_____________________________________ Province/State____________________

Postal/Zip________________ Country______________________

Telephone:(_______)_______________________ Fax number:(_______)______________________

E-Mail:______________________________________ P.O.Number:______________________________

Quantity	Code Number & Description	Price Each	Total
__________	____________________________________________	$_________	$______________
__________	____________________________________________	$_________	$______________
__________	____________________________________________	$_________	$______________
__________	____________________________________________	$_________	$______________
__________	____________________________________________	$_________	$______________
__________	____________________________________________	$_________	$______________
__________	____________________________________________	$_________	$______________
__________	____________________________________________	$_________	$______________
__________	____________________________________________	$_________	$______________
__________	____________________________________________	$_________	$______________
__________	____________________________________________	$_________	$______________
__________	____________________________________________	$_________	$______________
__________	____________________________________________	$_________	$______________
__________	____________________________________________	$_________	$______________
__________	____________________________________________	$_________	$______________
__________	____________________________________________	$_________	$______________
__________	____________________________________________	$_________	$______________
__________	____________________________________________	$_________	$______________
__________	____________________________________________	$_________	$______________
__________	____________________________________________	$_________	$______________
__________	____________________________________________	$_________	$______________
__________	____________________________________________	$_________	$______________
__________	____________________________________________	$_________	$______________
__________	____________________________________________	$_________	$______________
__________	____________________________________________	$_________	$______________
__________	____________________________________________	$_________	$______________
__________	____________________________________________	$_________	$______________
__________	____________________________________________	$_________	$______________
__________	____________________________________________	$_________	$______________
__________	____________________________________________	$_________	$______________
__________	____________________________________________	$_________	$______________
__________	____________________________________________	$_________	$______________
__________	____________________________________________	$_________	$______________
		Subtotal	$______________
	Terms Of Payment: (tick one)	Shipping	$__see_below___
	VISA_____, MC_____, AMEX_____, PAYPAL_____. On Account_____(Established Approved Customers Only).	Total	$___.T.B.A.___

Credit Card #:_______________________________________________
Expiry Date:_______________

Signature: ______________________________________________ all orders must be signed.

* 7% gst will be added to all orders shipped within Canada.
** 15% hst will be add to all altantic province's in Canada.
*** A PST number is required for B.C. Customers only. _____________.
**** Shipping charges vary on each order. We will charge you the exact shipping cost.
***** We will ship via the cheapest means unless specified._________________________.
****** On all international orders duties & taxes are the purchaser's responsiblity.

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12-20-04