Company Name

Federal Business No.

Full Name

Address

City

Province

Postal Code

Phone

Fax

Email

Company Description

Phone me with total and I will send cheque.

Charge me an extra $6.00 for sending C.O.D.

Phone me or fax me and ask me for my VISA, Mastercard number.

Applying for credit. I will fax 3 credit references. (709) 579-6196