In Canada: PBSCO 22968 122nd Ave, Maple Ridge, BC, Canada V3C 1A8

In USA: PBSCO P.O. Box 1421 Stanwood Washington, USA. 98292

Mail Order Form
To print a copy for mailing, click your browsers print button. Complete the form and mail it with your check, money order or Credit Card information to EITHER ADDRESS listed above.

Name:_________________________________________________

Shipping Address:________________________________________

City:__________________________ State/Prov:________________ Zip/Post:____________

Telephone Number:_________________ Fax:__________________ E-mail:_______________

Description	Quantity	Price	Shipping	Amount
Screen Saver Kit (100 Screen Savers)		$495.00US	$50.00US	$545.00US

SHIPPING:
All orders shipped Federal Express
All orders must include a Street Delivery Address, Name and Telephone Number to ensure delivery.

Prices:
All prices in US Dollars. Please include cheque or money order with your order if not paying with Credit Card.

Card Information:
Card type (VISA, MATERCARD, AMEX)_______________________________________

Name On Card:_______________________________ Card Number:_______________________

Expiration Date:_______________________________ Signature:___________________________