OPP WALL-ALBUM® -- Purchase Order

Wall-Album® - Order

Presented by our A1 Priorities Associate!

ORDER DETAILS
Item	Description	Quantity	Unit Price	Extended Price
WA-4612	Fridge Edition		US$19.95 CA$24.95
WA-4620	Mixed Edition		US$19.95 CA$24.95
WA-4625	Landscape Edition		US$24.95 CA$29.95
WA-2357	Collector Edition		US$19.95 CA$24.95
WA-2380	Business Edition		US$24.95 CA$29.95
I pay GST and PST (ONT) I pay GST (CA) I don't pay Sales Tax (US & INT)
Volume Discounts 10+ =10% 50+ =15% 100+ =20% 250+ =25%			Subtotal
			Volume Discount
* International Order
			GST (Canada)
Ship via			PST (Ontario)
			* Shipping (CA & US)


* Surface Mail is calculated as follows: First unit @ $8.00 plus additional units @ $1.50. Bulk (10 or more units) and International Orders are charged separately according to the Service rate.
SHIPPING DETAILS
* First Name
* Last Name
Title
Company
* Shipping Address(1)
Shipping Address(2)
* City
* State or Province
* Country
* Zip or Postal Code
Telephone No.
Fax No.
* E-mail
PAYMENT DETAILS
I am mailing my Cheque or MO:			Yes No, I have a Biospace Account
I want to pay by credit card:			Visa Mastercard
I'll phone in my card number:			Yes No, details provided below
** Credit Card Number:
Expiry Date:			mm yy

PLEASE PRINT & SAVE RECEIPT FOR YOUR RECORDS.
If "Server Error" appears, please click "Back" and "Place Order" again.
**If you have Security concerns, you can call (or print & fax Form) toll free to:
1-800-592-5286 (Canada & USA) or 905-278-7164 (Local & International).

To order by Mail, please print completed Form and mail with Cheque or MO to:

BIOSPACE CORPORATION
1720 Lincolnshire Blvd.,
Mississauga, Canada L5E 2S7
Tel/Fax (905) 278-7164

E-mail: sales@biospace-corporation.com

Orders are shipped on the day your Cheque, Money Order or Credit Card transaction is cleared by our bank (allow 5 business days). We ship via UPS or Parcel Post to most addresses in North America (allow 5 business days). For multiple and international orders, confirm shipping charges first (submit form above) or tel / fax 905-278-7164.

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Wall-Album®, PlayMaker®, Bathbar® & Washbar® are trademarks of Biospace Corporation.
Biospace® is a registered trademark of Biospace International AG. © Biospace Corporation.
All rights reserved. U.S. and International Patents apply or are pending.

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