ORDER CUSTOM
DISTRIBUTOR CASE HERE Canadian Distributor Order Form in US FUNDS
Shipping Information |
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| Name / Business | |
| Street Address |
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| 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 |
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Order Information in US Funds ( $250.00 US per case ) |
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| Extreme Power Plus |
CASE ( 36 ) - Quantity: x $250.00 = |
| Extreme Power Plus II ( NEW ) |
CASE ( 36 ) - Quantity: x $320.00 = |
| Instaburn |
CASE ( 36 ) - Quantity: x $250.00 = |
| Colon Cleanser |
CASE ( 36 ) - Quantity: x $250.00 = |
| Coral Calcium |
CASE ( 36 ) - Quantity: x $250.00 = |
| DISTRIBUTOR KIT |
OUT OF STOCK CURRENTLY - NO COST NOW |
| Sub Total |
Sub Total |
| Shipping |
Shipping is included in these prices |
| TOTAL |
Payable to Dutch International |
| Visa # |
|
| Name of Card Holder |
Expiry date |
| Signature of cardholder |
I do Authorize Dutch International to do a one time charge to my
VISA Card for the amount of $ US Funds per case if shipped from the USA _______________________________________ 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: NEW MAILING ADDRESS BELOW! BDL MOTORSPORTS Callingwood RPO P.O. Box 78009 Edmonton, Alberta T5T 6A1 Direct 780.499.8556 Fax 780.487.9899 *1st order Case(s) are shipped to you from head office in the USA. Please send me an e-mail before you sign up to see if I can ship you your case from Alberta or if it has to come from the USA ( first case order only ). Case price based on the current daily Canadian VISA card dollar conversion rate 1.46 ( May 22nd, 2003 ) 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. |
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Please make checks or money orders out to "BDL Motorsports" for the TOTAL amount above. Please make sure your shipping & GST calculations are correct.
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