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 ORDER
FORM
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Fax: (705) 735-0360 TOLL FREE: 1 (800) 922 4760
Mail: ScreenHouses Unlimited 13-4 Alliance Blvd, Suite 124 Barrie, ON. Canada L4M 7G3
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Product
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Order Date |
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Name
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Name |
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Ship to
Address
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Billing
Address (if different from 'ship to') |
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City
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City |
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State/ZIP
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State/Zip |
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Email Address
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Special Notation
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Res. Tel:
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Bus. Tel:
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Other Tel or Cell: |
Fax: |
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QTY |
Product # |
Size |
Colour |
Product Name |
Style / Shape
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Price |
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OPTIONS: |
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Additional
Purchaser Notes:
Select Method Of
Payment:
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1.
Credit Card: VISA
□
OR
MC
□
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2.
US Cashier's Check □ |
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Card# |
3 Digit Security Code |
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Item Price(s):
______________________________
______________________________
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Expiry: |
Name on Card: |
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Item Price(s):
______________________________
______________________________
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Subtotal |
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Subtract a 5%
Discount for Cashier's Check… |
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Total SALE: |
Total SALE: |
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