INJECTION LOCATOR ORDER FORM

Mail to address, or Fax to Fax # below
Sales and Promotion (Canada) PO Box 531 Delta, British Columbia V4K 4J7 -----------------------------------		Sales and Promotion (United States) PO Box 1826 Point Roberts, Washington 98281-1826 ---------------------------------
Product #	Product Description		Units		Cost Per	Subtotal
(64167-00010)	Economy Edition (CD-Rom)		_____	@	$59.95	$___.____
(64167-00011)	Economy Edition (Video Tape)		_____	@	$59.95	$___.____
(64167-00012)	Executive Edition ( CD-ROM )		_____	@	$89.95	$___.____
(64167-00013)	Executive Edition (Video Tape)		_____	@	$89.95	$___.____

TOTAL PURCHASES						$___.____

SHIPPING & HANDLING - (We will contact you to quote the exact price)						$___.____

TOTAL PAYABLE						$___.____

All Payments Are Made In Canadian Funds

Payment Method:	Visa MasterCard American Express	COD Cash Only($6.00) COD Cheque Only($6.00)	Certified Cheque Money Order
Credit Card # ________ - _________ - _________ - _________
Expiration Date: Year
Name as shown on Card: __________________________ Verification # ________________

Signature: _____________________________________________

Ship to: Name_____________________________Address________________________________

Address________________________________________

City / Town_____________________________ Prov. / State________________________

Postal / Zip code__________________ E-mail__________@_______________________

Phone #_______ - _______ - _________ Fax # _______ - ________- __________

Customer - COMMENTS OR SPECIAL INSTRUCTIONS - _________________________________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________

PLEASE MAIL IN THIS PAGE or FAX THIS PAGE fax # (1-866-250-2020) or PHONE IN THIS ORDER - (TOLL FREE 1-877-250-2020)
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INJECTION LOCATOR ORDER FORM

Mail to address, or Fax to Fax # below

All Payments Are Made In Canadian Funds

Customer - COMMENTS OR SPECIAL INSTRUCTIONS -

PLEASE MAIL IN THIS PAGE or FAX THIS PAGE fax # (1-866-250-2020) or PHONE IN THIS ORDER - (TOLL FREE 1-877-250-2020)

PLEASE MAIL IN THIS PAGE
or
FAX THIS PAGE fax # (1-866-250-2020)
or
PHONE IN THIS ORDER - (TOLL FREE 1-877-250-2020)