Fax Order form for "F. J. Dickens in the North West Mounted Police"

David J. Carter
Eagle Butte Press Ltd 1998
Box 39
Elkwater, AB. Canada.
T0J 1C0

Or fax it to: (403) 893-2470

Please call before sending a fax. No collect calls, and please do not send cash through the mail.

Name: _________________________
Phone: _________________________
E-mail: _________________________
Shipping Address: _________________________
Street or Box number: _________________________
City: _________________________
Province or State: _________________________
Country & Postal Code:_________________________

Qty:

Cost: ($22.00 each)

Shipping Canada/USA: ($8.00 per item) or

Shipping overseas (surface): ($10.00 per item) or

Total Cost:

Method of Payment:

    Cheque:__
    Money Order or Cashier's Cheque:__

Website by Merriman Webpages

Qty:
Cost:		($22.00 each)
Shipping Canada/USA:		($8.00 per item) or
Shipping overseas (surface):		($10.00 per item) or
Total Cost: