Fax Order Form
(Print this page, fill out all required fields, and fax to: 1-604-303-6790)


To:   MPS International Marketing Inc.

Order
Item Spec.

Quantity

     
     
     

We will call you or email you to confirm the total amount of your order.

Total Amount:   _______________

Name:  
Address:  

 

Fax Number:  

Tel Number:

 
E-Mail:  
Credit Card:    
MasterCard: ______                  Visa: ______
Card Number: __________________________ 
Expiration Date: _________________________
Name on Card:  _________________________
 

I hereby authorize MPS International Marketing Inc. to charge my credit card for the purchase of the above order.

 

       __________________________                                         _________________________
       Signature                                                                         Date

Note:  Your credit card will be charged for the price in Canadian dollars equivalent to the currency exchange rate at the time you place your order. The final charge on your credit card statement may be a bit different than the actual price in US$.  The charge will be under the name of:

MPS International Marketing Inc.