Please ensure that you fill out all the neccesary fields in order for your order or request to be processed as quickly as possible.

If you are an existing customer you do not need to fill out the "Invoice to" and "Ship to" information.
Your Name:  
Company Name:  
Type of Business:  
For resale:  Yes
 No

Is this an:

 Order, or
 Request for Price and Delivery

Are you a:

 New Customer, or an
 Existing Customer





Invoice to:


Name:

 
Address:  
City, Prov:  
Postal Code:  





Ship to: (if different from Invoice)


Name:

 
Address:  
City, Prov:  
Postal Code:  





You must at least supply a phone number in order for your request to be processed.

Phone:

 
Fax:  
Email:  




Your Purchase Order #:  
Are you PST Exempt?   Yes No (for Ontario only)
If 'Yes', PST #:  
Are you GST Exempt?   Yes No
If 'Yes', GST #:  
Ship Prepaid and Charge, or...
Carrier of Choice:  
Your Account #:  





Terms:



Visa Mastercard
Card #:  
Exp Date:  
Name on Card:  






Qty:

Item Description: