Name:

_______________________________________________

Mailing address:

_______________________________________________

City:

_______________________________________________

Province/State:

_______________________________________________

Postal Code/Zip Code:

_______________________________________________

Telephone:

_______________________________________________

E-mail:

_______________________________________________

Quantity

Item Number

Item Name

Price per Item

Total

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_________

_________

_________

_________

_________

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Subtotal:

_____________________

Canadians Add 6% GST:

_____________________

Ont. Residents Add 8% GST:

_____________________

Shipping:
($8 first item, $3 each additional item)

_____________________

Total:

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