Canadian orders will be accepted by Fax or Mail Order  credit cards accepted American Express, Master Card or Visa as well as money order or cheque. Orders paid for by cheque will be shipped when the cheque clears. Do Not Fill In This Form While Connected to The Internet.

Please provide the following contact information: Please print this is your shipping label.

First Name
Last Name
Street Address
Address (cont.)
City
Province
Postal Code
Home Phone
FAX
E-mail

Prices in Canadian Dollars

ZeeStop E-unit   Ont.  $ 134.95 Taxes Included
E-unit Outside Ont.$ 125.08 Tax Included
Replacement Filter in Ont.$ 40.19 Taxes Included
Replacement Filter Outside of Ont.$ 37.40 Tax Included

Number Items and Price of Order  E-unit:_______Filter Bag:______Total Price:$__________

Credit Card  American Express____ Master Card____ Visa____ please Check One.
         

Card #_______________________________________________

Expire Date ______________  Signature__________________________________
 

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Last modified: 01/21/07