Please Print this page out and Mail/Fax the copy to:   ORDER FORM
The MoodMaster™
11630 Kingsway Ave.
Edmonton, AB, Canada
T5G 0X5

FACSIMILE: (780) 424 - 4000
PHONE: (780) 424 - 7777
TOLL FREE: 1-800-661-9999

DATE: __________________
BILL TO:   SHIP TO: Same As Billing Address See Below
NAME/COMPANY
                                     
NAME/COMPANY
ADDRESS
                                     
ADDRESS
CITY
                                     
CITY
PROVINCE/STATE                         POSTAL/ZIP          
                                     
PROVINCE/STATE                         POSTAL/ZIP          
                                     
PHONE                             FAX      
PHONE                             FAX      
CONTACT PERSON CONTACT PERSON
METHOD OF PAYMENT: CASH/MONEY ORDER CHEQUE VISA MASTERCARD INVOICE
CREDIT CARD # : EXPIRY DATE        
______________________________________   ___________________________________________
CARDHOLDER NAME (AS IT APPEARS ON THE CARD)   SIGNATURE
QUANTITY ITEM DESCRIPTION PRICE TOTAL
 
Letter Size Print
8"x10" Moodmaster Print
$ 9.95
 
Poster Size Print
17"x23" Moodmaster Wall Poster
$19.95
 
Shipping & Handling


$2.00 - 8"x10" Print
$9.95 - 17"x23" Poster
     
SUB TOTAL:
     
(Canadian Residents) GST ADD 5%:
     
TOTAL

INTERNAL USE ONLY:

DATE OUT MARKTG CTR REP VIA CODE INVOICE NO. PROJECT