HEPA Filter............................................................Please ship me ___ L401 HEPA filters @ $24.95 ea. =________
Two Filter Special Pack...................Please ship me ___ L401 HEPA 2 Filter Special Packs @ $39.95 ea. =________
Six Filter Special Pack...................Please ship me ___ L401 HEPA 6 Filter Special Packs @ $89.95 ea. =________
Shipping and Handling = ____________
SubTotal = ____________
GST (5% of SubTotal) = ____________
Ontario Only PST (8% of SubTotal) = ____________
TOTAL (SubTotal + Taxes) = ______________
CDN Funds
Ship To: (Please Print)
Name: __________________________________________________________________
Street: __________________________________________ Apt: __________
Town/City: ______________________________________ Prov: __________
Postal Code: ____________ Phone: __________________________
Country.....Canada
Payment Information....(Please check one of the following)....Do not send cash by mail.
____ Check No. ____________ enclosed. Please make the check out to Carlisle Bay Co. Ltd.
____ Money order enclosed. Please make the money order out to Carlisle Bay Co. Ltd.
____ VISA....Name on the card: (Please Print) ______________________________________
Card Number: ______________________________________ Exp. Date: ______ / ______
Signature: _____________________________________ Date: ______________________