Fax Form: Print, Fill the form and Fax to: 1- 250-339-0286

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Number and Product Name:..........................................................

Total price:........................ 

Your Name:.........................................................   

Address:........................................................................................

City:....................................

State/Province:......................................

Country:..............................................Zip/Postal Code:......................

Email:..............................

Phone:.............................

Fax:....................

Discover, AmEx , Master card or VISA #................................................. 

Expiration date:................ 

Name on the credit card: .............................

Signature:..........................

For Repeat Customers Only: Send me the same order every ........... days charging the same credit card.  

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Thank you for your order we will  send you a shipping confirmation by Email or Fax as soon as is processed.