Jeune Bros. Tent & Awning                Order Form

Company Name:
Your Name:
Address: Apt/St number, Street 
  City / Prov. / Postal Code
Ship to: Apt/St number, Street

(if not same as above)

 City / Prov. / Postal Code

Purchase Order No:

Contact Person:  

Phone Number:      

Fax:                     

E-mail:                   

Web site:             

Date Ordered:         

Date Required:     

Special Instructions:

Quantity

Description

Unit Price

Extended Price

Payment by:    VISA    MASTERCARD  AMERICAN EXPRESS    MONEY ORDER

 Sub-total

Card Number:

 Handling fee (minimum $3.00)

Expiry Date:  

 Shipping

Name Shown on Card:

 GST

  PST

  TOTAL

Please print out and fax or mail to:

 Jeune Bros. Tent & Awning

570 Johnson Street, Victoria, Canada, BC V8W 1M3 

   Phone: 250 385-7751 Fax 250 385-7067 or Toll Free Fax 1-888-311-1522.

E-Mail: jeunebro@island.net

We will phone or fax you to confirm order. Thank You for your business.           

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