how to
O R D E R
the

by
CHECK or MONEY ORDER


HERE'S HOW:

 Fill in the Form below and Submit.
Then send your payment to one of the two addresses below.


Quantity of This Order:

Manitoba residents add 7% PST + 7% GST to total.

Price we Quoted you per Unit: **

**This is to accommodate occasional minor pricing variations based on either geographic sales region, charitable donation programs, or membership in a registered Buying Group.

- PLEASE FILL IN THE SHIPPING DETAILS BELOW -

Your Name
Contact Name (if different - for DHL waybill)
Shipping Address Line 1
Shipping Address Line 2
City State/Prov
Code: Zip/Postal
Country

Area Code
TEL# at the Shipping Address above (for DHL)
*E-MAIL ADDRESS*


Additional shipping details: front/side/back door, faster shipping, etc...

A Customer Representative will contact you to confirm the details of your order. Select your preferred method and point of contact:

EMAIL:
TEL:
FAX:

NOTE: After Submitting this form you will be linked to a page where you can view the particulars of your request. The company that provides us with this service is Response-O-Matic. The information you submitted can be found below an ad banner for a product we know nothing about. This is the modest compromise we are required to make in exchange for using Response-O-Matic's excellent form submission service. Thank You.
After submitting this form, you will find a link that will bring you back to this page so you can make note of the mailing addresses below.
Make CHECK or MONEY ORDER
payable to "Apollo Marconi"

MAIL TO:

APOLLO MARCONI
568 Osborne St. Suite 63002
Winnipeg, MB
R3L 2B0
CANADA
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