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orderf~2.txt
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1998-09-17
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965b
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dcsMixer OrderForm
e-mail this form to dcs@canada.com or fax it to (705) 326-1395.
Name:
Address:
City:
Province/State:
Country:
Postal/Zip Code:
Phone:
e-mail:
Credit Card Type:
(visa/master card)
Credit Card Number:
Credit Card Expiry Date:
Name on Credit Card:
Please note: Credit Card transaction will report
Davies Computer Services
If paying by cheque or money order, please send to
Adam G. Davies
179 Coldwater Road West
Orillia, Ontario
Canada L3V 3L7
Please allow 4-6 weeks for cheque clearing.
Please note: all prices are in Canadian Dollars.
PRODUCT DESCRIPTION QTY PRICE AMOUNT
dcsMixer v1.00 _____ $10.00 ________
_____ ______ ________
HardCopy Receipt $2.00 ________
(includes postage and handling)
SubTotal ________
(canadian residents please add) GST @ 7% ________
(ontario residents please add) PST @ 8% ________
Total ________