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Date: |
_____________________________ |
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PLEASE PRINT THIS FORM,
COMPLETE YOUR ORDER AND MAIL TO: |
Roger's Minerals
3171 Romeo Street Val Caron, ON Canada P3N 1G5 |
Additional Info:
rmineral@isys.ca Tel: 1-705-897-6216 |
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SEND
ORDER TO: |
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| Name: | _____________________________________________________ |
| Street Address: | _____________________________________________________ |
| City & Prov./State & Country | _____________________________________________________ |
| Postal/Zip Code: | _____________________________________________________ |
| _____________________________ |
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FROM FOSSIL LIST |
LOCALITY | SIZE | QUANTITY | $ AMT EA | TOTAL |
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*** Please ensure the above order is from the "
FOSSIL
" list. ***
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SUB TOTAL |
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| TOTAL $ SENT |
SHIPPING |
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| TOTAL ORDER |
ONT. RES. ADD 8% PST |
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| REFUND |
TOTAL |
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| REFUND SHIPPING CHARGES YES NO |
CREDIT SHIPPING ON NEXT ORDER YES NO |