P'lovers Online Order Form
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Date_______________ Name____________________

Address______________________________________ Postal Code__________

City_______________________ State/Province_____________

Country____________________ Daytime Phone______________

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  Product #   Qty.   Description (Size,color,etc.)    Price    Total  
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                  [] Merchandise Total:
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                  [] Shipping/Handling:
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                  []         Sub Total:
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     15% GST - Subtotal:
     If delivered in Canada
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                  []             TOTAL:
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Method of Payment:                         Thanks for your Order.
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Cheque or Money Order $____________        For Shipping and Handling

[] VISA [] Mastercard      For purchases up to $25.00....add $6.00 S&H

Card Number_________________________           $26 to $50....add $8.00

Expiry Date_________________________         $51 to $100....add $10.00

Expiry Date_________________________           Over $100....add $12.00

Name on Credit Card_____________________________

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P'lovers - 5657 Spring Garden Rd Halifax Nova Scotia CANADA B3J 3R4
Local Tel: 902 422 6060 Toll Free: 1-800-565-2998 Fax: 902 423 2877