Customer Order Form


	Customer Order Form	Catalogue with part#'s

Please provide the following information:

Contact Name
Title
Company Name
Customer No.
Phone
Address 1
Address 2
City
Province
Postal code
FAX
E-mail
Web

Please provide the following ordering information:

QTY. PART No. DESCRIPTION

Required Ship Date -- mm/dd/yy

P.O. #

Comments:

On-line orders are checked regularly. If no response is made to you after one business day, please call our Customer Service Department (905) 475-4220 or 1-800-405-6673 to confirm status.