Print this form and fax or mail to:
DIANA MAY CLAY 2004 LTD.
Box 28
Theodore, Saskatchewan, S0A 4C0, Canada
Voice (306) 647-2092 Fax (306) 647-2299
| Item # |
Qty. |
Item Description |
Size |
Price |
Total |
-
|
-
|
-
|
-
|
|
-
|
-
|
-
|
-
|
-
|
|
-
|
-
|
-
|
-
|
-
|
|
-
|
-
|
-
|
-
|
-
|
|
-
|
NOTE: Shipping and handling costs vary according to order.
Please call for shipping charges (306) 647-2092
| Name |
|
Sub Total |
|
| Address (shipping) |
|
In Canada add 7% GST.
Saskatchewan
residents add 6% PST as well. |
|
| City / State or Prov/ Zip |
|
Shipping & Handling |
|
| Phone Number |
( ) |
Order Total |
|
- IMPORTANT:
-
Fraud Prevention Security requires credit card address to
match billing address exactly.
|
Address (Billing) |
|
|
City / State or Prov. / Zip |
|
-
Circle one if payment is by credit card -
- Cash______ Check________ Credit Card_______
-
- Credit Card Account No._____________________________________
-
- Expiration Date:______/______
-
- Card Holders Signature: ______________________________________
from: DIANA MAY CLAY 2004 LTD