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
Order Information in Canadian Funds (shipping included ) |
|
| Extreme Power Plus |
Quantity: x $9.00 = |
| Extreme Power Plus II |
Quantity: x $9.50 = |
| Colon Cleanser |
Quantity: x $9.00 = |
| Fix-A-Fat |
Quantity: x $12.00 = |
| Cortaway 30 |
Quantity: x $10.00 = |
| N-Control |
Quantity: x $18.00 = |
|
YOU MUST ORDER A MINIMUM OF 36 BOTTLES AT THIS PRICE |
|
| DIST. KIT Reg. $20.00 |
OUT OF STOCK - FEE WAIVED CURRENTLY |
| Sub Total |
Sub Total |
| GST |
R133785204 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 $
in Canadian funds. _______________________________________ sign please
|
* I do need your SIN or your own Business GST number to sign you up.
| Order with Money Order, Visa or cheque ( time needed for cheque to clear ) 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 shipped to you from BDL Motorsports in Alberta, Canada via Canada post Expedited 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 ( that enough of each product that you would like is 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 |
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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. |