Food Smart Order Form

Please complete and submit the following information, or email us at marketing@quackersales.com . You may pay by VISA (provide your phone number below and we will call you), personal cheque, corporate cheque, or money order. Please indicate below what method of payment you would prefer. Applicable taxes, plus shipping and handling are extra.

NOTE: All information entered in the following form is used to place an order to Quacker's Sales & Service and will NOT be used in any other way. This will be formatted as an E-Mail message to us therefore do not send your credit card information since it is not a secure means of communication.

Please provide the following contact information:

Name

Street Address

Address (continued)

City

Province/State

Postal Code/Zip Code

Country

Work Phone

Home Phone

FAX

E-mail

Shipping address if different from above.

Street Address

Address (continued)

City

Province/State

Postal Code/Zip Code

Country

Please select the product and desired quantity below:

QTY DESCRIPTION

Please select method of payment:

Method of Payment

Comments?

Name
Street Address
Address (continued)
City
Province/State
Postal Code/Zip Code
Country
Work Phone
Home Phone
FAX
E-mail

	Shipping address if different from above.
Street Address
Address (continued)
City
Province/State
Postal Code/Zip Code
Country

Food Smart Order Form

Copyright © 1999 [Quacker's Sales & Service]. All rights reserved. Revised: March 06, 2003

Copyright © 1999 [Quacker's Sales & Service]. All rights reserved.
Revised: March 06, 2003