Online Order Form
Customer Information:
Name:
Company Name:
Vendor's Permit No.
Address:
City:
Province/State:
Country:
Postal/Zip Code:
Phone:
Fax:
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Order Items
Item Number
Qty
Cost
Total
GLX-072 PUR
$2.25 EA
GLX-072 RED
$2.25 EA
GLX-073 BEIGE
$5.75 EA
GLX-073 BLK
$5.75 EA
GLX-073 BRN
$5.75 EA
GLX-073 D BLUE
$5.75 EA
GLX-073 D RED
$5.75 EA
GLX-073 GRN
$5.75 EA
GLX-073 L BLUE
$5.75 EA
GLX-073 L RED
$5.75 EA
GLX-073 ORG
$5.75 EA
GLX-073 PINK
$5.75 EA
GLX-073 PUR
$5.75 EA
GLX-073 MET BLK
$5.75 EA
GLX-073 WHT
$5.75 EA
GLX-073 YELLOW
$5.75 EA
GLX-074 GRN
$6.00 EA
GLX-074 PINK
$6.00 EA
GLX-074 RED
$6.00 EA
HMS-001
$2.00 SET
HMS-002 BLK
$3.50 SET
HMS-002 BLUE
$3.50 SET
HMS-002 GRN
$3.50 SET
HMS-002 ORG
$3.50 SET
HMS-002 PUR
$3.50 SET
HMS-002 SILVER
$3.50 SET
HMS-002 WHT
$3.50 SET
HMS-003 BEIGE
$2.50 EA
HMS-003 BLK
$2.50 EA
HMS-003 D BRN
$2.50 EA
HMS-003 L BRN
$2.50 EA
HMS-004 BLK
$5.50 EA
HMS-004 WHT
$5.50 EA
HMS-005 BLUE
$2.50 EA
HMS-005 GRN
$2.50 EA
HMS-005 RED
$2.50 EA
HMS-006 BLUE
$2.50 EA
HMS-006 ORG
$2.50 EA
HMS-007
$3.00 EA
Item Number
Qty
Cost
Total
HMS-008 DARK
$3.50 EA
HMS-008 LIGHT
$3.50 EA
HMS-009 BEIGE
$5.50 EA
HMS-009 BLK
$5.50 EA
HMS-009 BRN
$5.50 EA
HMS-009 RED
$5.50 EA
HMS-009 WHT
$5.50 EA
HMS-011 BEIGE
$5.50 EA
HMS-011 BLK
$5.50 EA
HMS-011 PUR
$5.50 EA
HMS-013 BLUE MULTI
$5.00 EA
HMS-013 BRN
$5.00 EA
HMS-013 ORG MULTI
$5.00 EA
HMS-013 RED
$5.00 EA
HMS-014 BLK
$2.00 EA
HMS-014 BRN
$2.00 EA
LAE-001
$2.25 EA
LAE-002
$3.95 EA
LAE-003
$3.95 EA
LAE-004
$3.95 EA
LAE-006
$3.95 EA
LAE-007
$3.95 EA
LAE-008
$3.95 EA
LAE-009
$2.00 PR
LAE-010
$2.00 PR
LAE-011
$2.00 PR
LAE-013
$3.25 PR
LBR-001 BLK
$5.00 EA
LBR-001 BLU
$5.00 EA
LBR-001 PUR
$5.00 EA
LBR-001 GRN
$5.00 EA
LBR-001 PINK
$5.00 EA
LBR-003 PUR
$2.00 EA
LBR-003 BLK
$2.00 EA
LBR-003 BLUE
$2.00 EA
LBR-003 BEIGE
$2.00 EA
LBR-003 0RG
$2.00 EA
LBR-003 GRN
$2.00 EA
LBR-003 PINK
$2.00 EA
Sub total
GST (5%)
PST (8%)
Total
