NexTV Canada Fax/Mail Order Form

To order from our products, please print this form. Complete the required information and mail or fax it to us along with your payment information to:  Orion Electronics Supplies Inc., 40 Lancaster St.West, Kitchener, Ontario Canada N2H 4S9. All orders must be prepaid. Signed credit card orders are accepted by fax as well: Fax: 1(519) 576 9028 Thank you for your interest in our products. Phone: 1(519) 576 9902

Fax to: Orion Electronics Supplies Inc. 40 Lancatser St. W. Kitchener, Ontario, Canada. N2H 4S9

NAME:
Phone: Fax: E-mail:
Address:
City: Province: Postal Code:
Item number Type of Package Description   
Unit Price
Total Price
         
         
         
         
         
         
         
Subtotal
  
Billing Information

Shipping

  
All prices in Canadian Funds!
GST 6%
  
Charge My: Mastercard VISA  Check or Money Order
PST 7% (Ontario)
   
Credit Card Number: ______________________________ __ Name of Bank:
Expiration: Total  
Name as on Card:

Signature:

Orion will confirm Shipping & Insurance with you before processing your order.

NexTV Canada - 40 Lancaster St. West Kitchener, Ont. N2H 4S9
Phone: 1 519 576-9902 Fax: 1 519 576-9028 - Email sales@orioniptv.com - Web: www.orioniptv.com

Copyright © Orion Electronics Supplies Inc. -2009