Order Form - Salt Spring Dollars

Order Form


$$10 Artist's Proof	$$20 Artist's Proof	$$10 Printer's Proof	$$20 Printer's Proof

A FREE CheckMate is included with each order so that you can see
the HALO covert features.

To protect our clients from credit card fraud, we must have the original signature of the cardholder on file PRIOR to shipping your order.

Full Name:
Address:
City:	Prov/State:
Postal/Zip Code:	Country:
Day Time Phone No.:
Email:
$$10 Artist's Proof:	Units X $35 Cdn - Total:
$$20 Artist's Proof:	Units X $50 Cdn - Total:
$$10 Printer's Proof:	Units X $50 Cdn - Total:
$$20 Printer's Proof:	Units X $70 Cdn - Total:
Additional CheckMate:	Units X $10 Cdn - Total:
Shipping:	Canadian Orders add $10 Cdn US and International Orders add $20 Cdn
Grand Total:	include any applicable taxes
VISA or MasterCard No.:
Expiry Date:
Card Holder Name:
Signature:

Canadian orders must add 7% GST + 8% PST (Ontario shipments only)
ALL SALES ARE FINAL

Print and fax form to 416-961-3890 of immediate shipment.
Or you can mail your payment (money order or check) with this form to:
AdlerTech International Inc.
1235 Bay Street, Suite 1000. Toronto, ON. Canada M5R 3K4.