Canadian Distributor Order Form

Shipping Information
Name / Business  
Street Address

City
Province
Postal Code 
Phone Number
Fax Number
Social Ins. Number * GST or SIN needed
Business GST Number * GST or SIN needed
Email Address

Web Site URL

                

 

 

 

 

 

 

 

 

Page 2

CASE Order Information in Canadian Funds (shipping included )
Extreme Power Plus ( 36 )

Quantity: x $325.00 =

Extreme Power Plus II ( 36 )

Quantity: x $340.00 =

Colon Cleanser ( 36 )

Quantity: x $325.00 =

Fix-A-Fat ( 36 )

Quantity: x $410.00 =

Cortaway 30 ( 36 )

Quantity: x $360.00 =

DISTRIBUTOR KIT

  OUT OF STOCK CURRENTLY - NO COST NOW 
Sub Total

 

 Sub Total

 

please read info below* ADD 7% GST

TOTAL

   Payable to BDL Motorsports

Visa #

Name of Card Holder

Expiry date

Signature of cardholder  I do Authorize BDL Motorsports/Mr. Dent to do a one time charge to my VISA Card for the amount of  $

 _______________________________________ sign please

*   I do need your SIN or your own Business GST number to sign you up.

   ORDER CUSTOM DISTRIBUTOR CASE HERE        

Order with Money Order, Visa or cheque please
Please type / fill out this form, print it, and fax it to 780 487-9899 or send to:

MAILING ADDRESS BELOW!

BDL MOTORSPORTS

P.O. Box 78009

Callingwood RPO

Edmonton, Alberta T5T 6A1

Direct 780.499.8556  Fax 780.487.9899

Case(s) are either shipped to you from BDL Motorsports in Canada via Canada post surface mail with insurance and delivery conformation. Please send me an e-mail before you sign up to see if I can ship you your case from Alberta to confirm I have enough product in stock.

Case price based on the current daily Canadian VISA card dollar conversion rate 1.26 ( February 1st, 2005 )

Please E-mail me at bdlmotorsports@shaw.ca if you have any questions

Please FILL OUT THIS FORM completely then just PRINT IT OUT and your info will show up on the order form when printed. Please make checks or money orders out to "BDL Motorsports" for the TOTAL amount above.  Please make sure your shipping & GST calculations are correct.