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BILL TO/SHIP TO

   All the fields must be completed.

Name
Address
Address
City
State / Province
Zip /  Postal Code   
Work Phone
Home Phone
Fax
E-mail Address

Payment Method

Cheque or Money Order enclosed (by mail only)

          

C.O.D. (Canadian Customers Only)

        Credit Card  

Visa  Mastercard  American Express
Name on Card
Credit Card Number
Expiry Date    
Signature
Amount of Order  

Currency

 Canadian    US Dollars
Place your Order Mail your order to the address below,
or for faster service, order toll free : 1-888-377-6259
or fax directly to 1-888-797-0779

Rocky Mountain Direct Merchants
3997 Grant Street
Burnaby, BC, Canada
V5C 3N4

 

 

Style Number

Description

Size

Colour Choice
1st                           2nd

 QTY

UNIT PRICE

TOTAL PRICE

 

 

 

 

 

 

   

 

 

 

 

 

 

   

 

 

 

 

 

 

   

 

 

 

 

 

 

   

 

 

 

 

 

 

   

 

 

 

 

 

 

   

 

 

 

 

 

 

   

 

 

 

 

 

 

   

 

 

 

 

 

 

   

 

 

 

 

 

 

   

 

 

 

 

 

 

   

 

 

 

 

 

 

   

 

 

 

 

 

 

   

 

 

 

 

 

 

   
Shipping Base Flat Rate (Approx. 10 Business Days) ($9 CAN or $5.85 USD)

 

 

Add $6.00 for Express Delivery (Approx. 5 Business Days) (Canada Only)

6.00

 

C.O.D.  Orders (Available in Canada only)

11.00

 

Air Staged areas, add 4.50

4.50

 

PST 7.5% (In BC only)

7.5%

 

GST 7% (Canada only)

7%

 

HST 15% (In Maritime Province only)

15%

 

Total Order