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Date |
_____________________________ |
| 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 |
|
SEND
ORDER TO: |
|
| Name: | _____________________________________________________ |
| Street Address: | _____________________________________________________ |
| City & Prov./State & Country | _____________________________________________________ |
| Postal/Zip Code: | _____________________________________________________ |
| _____________________________ |
| FROM MAIN MINERAL LIST |
LOCALITY | SIZE | QUANTITY | $ AMT EA | TOTAL |
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*** Please ensure the above order is from the "Main Mineral" 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 |