Resperin Order Form: Canadian

Just fill in the required information, print and mail or fax.

Mail to:    Resperin™ Canada Ltd.

                420 Erb St. W. Suite 5-209

                Waterloo, Ontario N2L 6K6

Fax:        1 (519) 725 4864

Name:              

Address:   

City:                    Province:    Alberta British Columbia Manitoba New Brunswick Newfoundland Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon

Postal:                Phone:       

Product Request:    1 Bottle Resperin's Caisse Formula Tea $45.00 + (GST) $3.15 + (Shipping) $7.00 = (Total) $55.15 2 Bottles Resperin's Caisse Formula Tea $90.00 + (GST) $6.30 + (Shipping) $7.00 = (Total) $103.30 3 Bottles Resperin's Caisse Formula Tea $135.00 + (GST) $9.45 + (Shipping) $7.00 = (Total) $151.45 4 Bottles Resperin's Caisse Formula Tea $180.00 + (GST) $12.60 + (Shipping) $7.00 = (Total) $199.60 5 Bottles Resperin's Caisse Formula Tea $225.00 + (GST) $15.75 + (Shipping) $7.00 = (Total) $247.75        

(All orders processed in Canadian Funds and all local taxes are identified by local laws)

Payment Method:    Cash    Cheque    Visa    Master Card    Money Order

If paying with Visa or Master card, fill in the following additional information.

Card #                        Expiration:    mm yy

After printing this page, click here to return to the order page, or visit our home page.