ORDER FORM

Call 1-800-668-5131

Qty.
Item #
Description
Price
Amount
         
         
         
         
         
         
         
         
         
All prices in Canadian dollars. Terms: Net 30 days. Shipped via Canada Post Expedited. (Prices subject to change without notice.)  
Subtotal
  
Shipping and Handling (add 8%)
Minimum charge $7.00; additional charge for 2 day air
  
5% GST or 13% HST for NS, NB & NF
  
TOTAL
  

Call 1-800-668-5131
Fax: (403) 556-1768

Order payment method:

__ Enclosed is my cheque or money order
__ Bill my organization/ school P.O. #: ________________________
__ Charge to my credit card
   __ VISA Card # ______________________ Expiry Date ________
   __ MasterCard # _____________________ Expiry Date ________

Authorized Signature _____________________________________

Mailing Address:

Name ___________________________________
Title ____________________________________
Organization ______________________________
Street ___________________________________
City _____________ Prov. ___ Code ___________
Day phone (___) ___________________________
Fax Number (___) __________________________
E-mail Address _____________________________

Bill To: (if different from shipping address)

Name ___________________________________
Title ____________________________________
Organization ______________________________
Street ___________________________________
City _____________ Prov. ___ Code ___________
Day phone (___) ___________________________
Fax Number (___) __________________________
E-mail Address _____________________________
www.activeparentingcanada.com ACTIVE PARENTING CANADA INC.