Today's Date: _______________________________


Ship to:

Name: ____________________________________________________________________

Institution: _____________________________________________________________

Address: _________________________________________________________________

City: _____________________________________  

Province: _____________________________________

Postal Code: _____________________________________

Daytime Phone: (_____) _______________________

Fax: (_____) _______________________

E-Mail: __________________________________________________________

Job Title: _____________________________________________________



Bill to or Credit Card Billing Address: (if different from above)

Name: ____________________________________________________________________

Institution: _____________________________________________________________

Address: _________________________________________________________________

City: _____________________________________  

Province: _____________________________________

Postal Code: _____________________________________

Daytime Phone: (_____) _______________________

Fax: (_____) _______________________

E-Mail: __________________________________________________________



Item 	                                            Unit               Item 
Number - Title                                      Price - Quantity - Total
___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

                                              Materials Total _____________

NOTE: Prices are expressed in U.S. dollars, and payment must be made
in U.S. dollars.

Shipping and Handling/GST
Add 12% for shipping and handling ($10.00 minimum). Include 5% GST.

Orders are normally shipped within 24 hours. Prices and terms are effective
beginning January 1, 2008, and are subject to change without notice.



___ Check or organizational purchase order enclosed.

___ Visa    ____ MasterCard     ___ Discover/Novus     ___ American Express

Exp. Date ______________  Name on Card ___________________________

Card No.________________________________ 

Phone No.(required)_________________________