LACY WEST Mail/Fax ORDER FORM

Lacy West Homepage
Lacy West Jewellery Tools and Supplies
#102 - 480 Smithe Street, Vancouver, British Columbia, Canada, V6B 3C1
       Tel:  604-669-LACY (5229), Fax: 604-628-4480
             Toll Free Phone 1-800-667-4118

Company Name: ____________________  Phone Number: _______________
Contact Person: __________________  Fax Number: _________________
Street Address: _________________________________________________
                               _________________________________________________
City: ___________________________   Province/State: _______________
Country: _________________________  Postal Code: _______________
E-Mail: __________________________  WebPage URL: ________________
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SHIPPING INSTRUCTIONS: Sample Shipping Costs

Vancouver: (Local Courier - Same/Next Day)  (XpressPost - 1-2 Days)
Canada:    (Priority Courier - Next Day)  (XpressPost - 1-2 Days)
           (Greyhound Courier - Days)  (Expedited - 2-7 Days)
USA:       (Air Mail)  (Surface Mail)
OverSeas:  (Purolator - 1-3 Days)
           (Air Mail - Weekish) (Surface Mail - 4-8 Weeks)
Specify Other:__________________________________________________
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BILLING INSTRUCTIONS:

Credit Card:   (VISA) (MASTERCARD)
        Card #:________________________________ Expiry Date: ________
        Name on Card: __________________________ 3-Digit Security Code ____
Other:         (LACY WEST ACCOUNT) (COD - only in Canada)
Tax Exemption Numbers : _________________________________________
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CUSTOMER ORDER
Code | Item Description  | Quantity | Price/Unit | Total Price