Mohair La Pinède - Mail Order Form                      « Help ? »
Name :
E-Mail : Telephone :
Adress : Apt. :
City : Province : Postal Code :

Style
Color
Size
Price
Quantity
Cost
Sub-Total
Postage
9.00$
G.S.T. (5%)
P.S.T. (9.5%)
Total

Methods of payment :     Check     Money Order     Visa     MasterCard

Card Number :    Expiry Date :

Signature : ____________________________________


Send your form to :

La Pinède
3499, rang Savary
St-Antoine Abbé (Québec) J0S 1N0

Or by FAX : (450) 827-8558