order-title.jpg (9174 bytes)

Note: To order, please print out this form, fill it out properly, and then FAX it over to us.
Fax #: 1-403-274-4481

  

Order Form

 

Download the order conformation form here (Word file).
Note: For credit card payment, please fax to us a copy of the front and back of your credit card, a copy of your photo ID and the order confirmation form. The signature on the photo ID must match the signature on the back of the credit card. Please note that CVV2 security no. is is a 3 digit number on the back side of the Visa or Master card.


 

 

 

Order Confirmation

No.                                                                   Date:.  /   /      
          Customer:                                                               
          Shipping Address  :                                                     
          State/Province:.              Postal/Zip Code:                                     
          Goods Delivery By: o UPS        o Federal Express     o Other:            
          Tel: (       )                            Fax:   (      )                           
          E-Mail:
                                                                
          Company Identification No. For Customs Purposes
(E.I.N., V.A.T., Importer No., Tax ID No., etc)
                                                                                                                                                               


          Payment:  
o Master Card ( CA$ Only)  o Visa Card ( CA$ or US$)

          Card Holder:                                                               
          Card No. :                                                                   
          Expire Date :                                            CVV2 Security No.                       

Card Holder's Signature:                                                              

Order Details: 

No.

Model No.

Unit Price

Quantity

Sub-Total US$

Sub-Total CA$

1.

 

 

 

 

 

2.

 

 

 

 

 

 3.

 

 

 

 

 

 4.

 

 

 

 

 

 5.

 

 

 

 

 

 6.

 Shipping Charge

 

 

 

 7.

 Subtotal

 

 

 

GST (5%)

 

 

 

 Total:

 

 

 

PS: For Credit purchases: I agree to pay the above total amount according to card issuer agreement.

Order Confirmed By  

 

------------------------------

Customer Signature

 

mailto:peterchen@microyal.com