ORDER FORM
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Ship to:

Company
Address
City
Province
Postal Code
Phone #
Fax #:
Terms:  Account COD Credit Card
Name of Cardholder
Card Number:
Card Expiry Date: Month:  Year: 
   
Qty. Part # Description Price Each

Cdn$
Cdn$
Cdn$
Cdn$
Cdn$
Cdn$
Cdn$
Cdn$

If you have any questions or comments, please feel free to contact us at 1-800-828-1496.

To place your order, please print this form and send to Fax: 905-683-7067
  Mail: Heat Seal Equipment
530 Westney Road South, Unit #1
Ajax, Ontario, Canada
L1S 6W2