Please read the ORDERING POLICIES on this web site before placing your order. Thank you.
Contact Information
Name: ___________________________________________________________________
Company / Dept.: ___________________________________________________________
Address: __________________________________________________________________
City / State: ________________________________________________________________
ZIP: _______________________________ Country: _______________________________
Phone: ( _____ ) _____________________ Fax: ( _____ ) ___________________________
E-mail:
____________________________________________________________________
Product Information
List additional products on the reverse of this page, or on another
page.
Product or Product Code Plus Shipping -----------------------------------------Price ---- Currency
1.
____________________________________________________________ ---- _______
2.
____________________________________________________________ ---- _______
3.
____________________________________________________________ ---- _______
4.
____________________________________________________________ ---- _______
5.
____________________________________________________________ ---- _______
6.
____________________________________________________________ ---- _______
7.
____________________________________________________________ ---- _______
8.
____________________________________________________________ ---- _______
9.
____________________________________________________________ ----
_______
10. ___________________________________________________________ ----
_______
TOTAL -----------------------------------------------------------------------____________ ---- _______
Shipping Cost: ------ q Included ------ q Not Included ------ q Please Calculate
Method of Payment
Please enclose full
payment with your order. Check method of payment:
q Check ------
q Money Order ------ q
Bank Draft ------ q VISA
q MasterCard ------ q
Other
Check / Money Order / Bank Draft # _______________________ Amount $ ______________
Charge the Amount of $
_________________________________ to my VISA or MasterCard
Card Number:
__________________________________ Exp. _______________________
Print Name
on Card: _____________________________ Signature: ____________________
Fax
your order, if paying by VISA or MasterCard - Fax: (604) 271-9414
Date: ________________________________
Signature: ____________________
CHECKS, MONEY ORDERS AND BANK DRAFTS
SHOULD BE MADE PAYABLE TO THE ADDRESS NOTED BELOW. FOR ADDITIONAL
INFORMATION
Call/Fax: 604-271-9414, OR E-mail:
msimics@direct.ca
Send To:
Apitronic
Services
9611 No. 4 Road
Richmond, B.C., V7A 2Z1
Canada
Ph./Fax:
(604) 271-9414
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Copyright © 1999-2005
Mihály Simics. All Rights Reserved.
Apitronic
Services, 9611 No. 4 Road, Richmond, B.C., Canada, V7A 2Z1, Ph./Fax (604)
271-9414
e-mail: msimics@direct.ca |
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