ORDER FORM
SHIP TO:
NAME: ______________________________________________
ORDER FORM
SHIP TO:
NAME: ______________________________________________
COMPANY: __________________________________________
ADDRESS: __________________________________________
ADDRESS: __________________________________________
CITY: ___________________________
STATE: _____________ ZIP: __________________
PHONE: ______________________________
FAX: _________________________________
E-mail: _______________________________
| DESCRIPTION |
QUANTITY
|
PRICE
EA.
|
TOTAL
|
|
PT Reader Interface
with 1pc. Logger Button ($189 + $27) |
|
x $216.00 U.S | |
|
MERCHANDISE
TOTAL |
|
||
|
UPS
SHIPPING "RED"
TO U.S. AND CANADA |
 |
1-4
pc $15 |
|
|
TOTAL
AMOUNT
|
$USD |
VISA:
 MASTERCARD:
|
Please
Print Clearly:
|
| NUMBER ON CARD: | |
| NAME ON CARD: | |
| EXPIRY DATE: | |
| AMOUNT | $ USD |
| SIGNATURE |
THIS ORDER FORM MAY BE FAXED
TO PHOTOLOGIC LTD. AT:
FAX: (905) 377-8692
Or TO
ORDER: ...E-mail the information to Rick Hoffman:
rhoffman@sympatico.ca
Or TO ORDER: ...Telephone: (905) 377-8915
PHOTOLOGIC LTD. FEDERAL
BUILDING • 39 QUEEN ST., SUITE 214 • COBOURG, ONTARIO K9A-1M8 •
CANADA
TEL: (905) 377-8915, FAX (905) 377-8692
