Veratika Canada Hard Copy Order Form PRINT ME! For Fax , Mail/Post , Byhand or Courier Orders Date:
Product (Instructions) Quantity (Instructions) Unit Price (Instructions) Total (Instructions)
       
       
       
       
       
       
       
       
       
Subtotal 
Shipping and Handling (see Shipping and Handling Price Table below) 
Grand Total (applicable taxes are included in price) 
Bill to (Instructions):
Name:
Street Address:
R.R./Box:
City/Town:
Prov./State:
P.Code/Zip:
Country:
Phone/Fax:
E-Mail:
 Ship To (Instructions):
 
 
 
 
 
 
 
 
 
Mail/Post:
Veratika Canada,
Suite 702,
258 Lisgar St.,
Ottawa Canada
K2P 0C9
OR
Fax:
Canada 613-231-5115
Shipping&Handling (Instructions)
Ottawa-Gatineau $6
Canada $15
USA50 $19
Americas$29
Austral-Eurasia $39
Africa-Antarctica $49
Method of Payment
(Instructions)
Cheque Money Order Amount $
Visa MasterCard Amex
Card Number 
Expiry Date  
Card Name  
Signature  
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