Order Form

Print and complete this order form, and fax or send to:


4167 Oakridge Crescent
Victoria, B.C.
Canada V8Z 4X8

or

Phone or Fax 1-250-744-3313

For more information, call toll free

1-800-818-2202

Contact us by E-mail at info@urban-astronaut.com

Please contact us for volume discounts and for custom orders for groups.

Date:
Sold to:
Name: Bus. Phone: Home Phone:
Address:
City: Prov./State: Code/Zip:
Ship to:
Name: Home Phone:
Address:
City: Prov./State: Code/Zip:
DESCRIPTION COLOR QUANTITY SIZE ITEM PRICE TOTAL
           
           
           
           
           
           
           
           
           
           
Merchandise Subtotal
  
Shipping & Handling
  
TOTAL
  
Canadian Residents add 7% GST
  
BC Residents add 7% PST
  
TOTAL
  

Shipping and handling:
(Canadian & U.S. customers)

0 - $50 .................... $5.00
$50.01 - $100 ........ $9.50
$100.01 - $200 ...... $10.00
$200.01 or more ..... $20.00

Payment method by Cheque, Money Order, VISA, or Mastercard
(US Customers-Payment by VISA only)

VISA/Mastercard No.:_________________________ Exp ___ /___

(Do not send cash. Sorry, no C.O.D. orders)

Please make cheques payable to Urban Astronaut

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