Order by FAX, Phone or Mail ---- USA and International Order Form

Order by FAX, Phone or Mail ---- USA and International Order Form USA and International Order Form -------- Order by FAX, Phone or Mail

Fax completed form to: 1 - 519 - 462 - 2002 (VISA or MasterCard)
Call us Toll Free at: 1 - 877 - 245 - 7444 (VISA or MasterCard)
OR
Mail completed form to:
Carlisle Bay Co. Ltd.
59 Harwood St.
Hickson, ON
N0J 1L0
Canada
I own a Eureka vacuum cleaner

HEPA Filter.....................................Please ship me ___ E103 HEPA filters @ $24.95 ea. =________
Special Pack......................Please ship me ___ E103-2 HEPA Special Packs @ $39.90 ea. =________
6 Pack Super Special.........Please ship me ___ E103-6 Pack Super Special @ $89.95 ea. =________

Shipping and Handling....Approximate delivery times: 14 days via Parcel Post, 7 days (Guaranteed) via XPRESSPOST-USA
Parcel Post = FREE
Optional XPRESSPOST-USA =$6.95

Shipping and Handling = ____________

TOTAL including S&H = ______________
US Funds

Ship To: (Please Print)

Name: __________________________________________________________________

Street: __________________________________________ Apt: __________

Town/City: ______________________________________ State: __________

ZIP Code: ____________

Phone: __________________________

Country.....USA.....Other___________

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 ____ MasterCard....Name on the card: (Please Print)______________________________________

Card Number: ______________________________________ Exp. Date: ______ / ______

Signature: _____________________________________ Date: ______________________