|
|
ORDER FORM Please print out this page mail with your payment. |
Name: _________________________________________________________________ Address: _______________________________________________ Apt. ___________ City: __________________________________ Prov/State ______________________ Pcode: _____________________________ Phone ____________________________ |
Item Description (size & colour) Please Print |
Price |
________________________________________________________________ |
TOTAL ENCLOSED |
Mail Money Order or cheque to: |
Alex Szwed 75 South Belair Dr. Woodbridge, ON. L4H 2N4 Canada |
Qty. |
Please Print |
Do not send cash. |
__________________ |
Subtotal |
Shipping & handling |
___________________ |
Total Amount |
___________________________________________________________________________ |
___________________________________________________________________________ |
__________________ |
Payment can be made at Paypal.com to: Hypnosman@rogers.com |