The 'Slipp-R' Safety Toe Order Form

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Please complete the following form:

Note: Shipments of over $200 to the US will incur Customs and Brokerage Fees. These are the responsibilities of the receiver.

International shipments MAY incur customs/brokerage fees. These are the responsibility of the receiver.

Billing Address:
Name:
Company:
Email:
Address:
City:
State/Province:
Zip/Postal Code:
Phone Number:
Fax Number:
Country: Canada
   
Shipping Address (If different from billing):
Name:

Company:

Address:

City:

State / Province:

Zip / Postal Code:

Phone Number:

Country:

   
Payment (If you are not purchasing with a credit card, please send this order form along with your cheque):
Card Number:

Name on Card:

Credit Card Type:

Expiration Date (MM/YY):

   
Order Details :
Size
Quantity @ $29.95 CDN
Cost
XX Large: $0.00
# of Units Shipping Price
2 $13.00 CDN
3 $15.00 CDN
4 $16.00 CDN
5 $17.00 CDN
6 $19.00 CDN
7 $21.00 CDN
8 $23.00 CDN
9 $25.00 CDN

FREIGHT COSTS ARE SUBJECT TO CHANGE WITHOUT NOTIFICATION.
X Large: $0.00
Large: $0.00
Large Dress: $0.00
Medium: $0.00
Small: $0.00
Extra Small: $0.00
Extra Extra Small: $0.00
     
Subtotal: 0 units $0.00
Shipping Cost:   $0.00
Tax:   $0.00
Grand Total:   $0.00

 

Signature:
 
When the form is complete, please print it, sign it, then fax or mail it to us!

Acknowledgement of receipt will be sent to your email address

Safetytoes International Inc.
221 Sheppard Avenue West
North York, Ontario   M2N 1N2
TEL: (416) 222-3609 ext. 26
FAX: (416) 733-8717