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SOLD TO: _________________________    SHIP TO: ____________________________
ADDRESS: _________________________   ADDRESS: __________________________
CITY: ____________PRO: ____________    CITY: ____________  PRO: _____________
TEL: _____________P.CODE: _________     TEL: _____________  P.CODE: __________
FAX: ________________________ EMAIL: ________________________________
OWNER'S NAME:____________________ SHIP VIA:____________________________
FOB MISSISSAUGA:__________________SHIPPING DATE: ______________________

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SPECIAL INSTRUCTION:  ____________________________ TOTAL:___________________

WE ACCEPT CREDIT CARD

BUSINESS PERMIT NO:____________PST NO:__________BUYER'S NAME:__________

VISA/MASTER CARD NO:___________________________SIGNATURE:______________

EXPIRY DATE:________CARD'S NAME:__________________OTHER TERMS:_______________