(Print this page, fill in your details, and fax us the 'ORDER FORM' portion only.  Hit 'Back' to return to web)
CanadianMoose.com ORDER FORM  All prices in Canadian Dollars (CAD$).  PLEASE PRINT CLEARLY.
Purchaser ('Bill To') Information (* = required field)              Date (YYYY/MM/DD): ______/____/____
*Name:    _____________________________   Company Name: ___________________________
*SSN/EIN: [                                  ]  <= AAAAA VERY IMPORTANT! - see bottom of 2nd page for details
*Address: ___________________________________________________
*City:       _____________________    *Province/State: _______________
     *Postal / Zip Code: __________________   *Country: ____________   Fax #: ( _____ ) _____-______
Telephone #: *Hm ( ____ ) _____-______  Wk ( ____ ) _____-______ Ext. ____  *E-mail: ________________
May we add you to our E-MAILING LIST (list IS NOT passed on to other parties)?  ___Yes  ___No
*How will you be paying?   (check one)   ___PayPal   OR
___VISA     ___MasterCard     ___AMEX  (PLEASE PRINT ALL NUMBERS CLEARLY)
Credit Card#:[               ]-[               ]-[               ]-[               ]  ExpDate (MM/YY):[        ]-[        ]  SID#:[          ]
      Name on credit card: ___________________________
      Signature: _____________________________  (credit card payment cannot be processed without this)
If responding to a promotion, please enter Promotion #: ____________
USA shipment only: ___Air  ___Surface  ___Courier  ___NotApplic(includes those orders with FREE shipping)
'Would Like By' Date (YYYY/MM/DD): ______/____/____ <= BBBBB see bottom of 2nd pg for dtls
'Cancel If Not Delivered By' Date (YYYY/MM/DD): ______/____/____ <= CCCCC see bottom of 2nd pg for dtls
                             Order Details (if you need additional space, please use extra copies of this Order Form)

Your comments OR How did you hear about us (web / printed advertisement, etc.)?  Which web site were you searching on (e.g. Yahoo / Alta Vista, etc.)?  What 'keywords' did you search with? _____________________________________________________________________________________

'Ship To' Information (please complete this section ONLY for products being shipped to an address other than the 'Purchaser Information' one above.  Note: Shipping & Handling charges will be calculated separately for each address.)
        (If you have additional 'Ship To' addresses (or additional Products for the same 'Ship to' address), please use extra copies of this Order Form)
Should we forward the 'Bill To' paperwork (Invoices, etc.)
        to the 'Ship To' address (below) as well? ____YES ____NO
Product #: ______________ Quantity: _______
Name:    _____________________________   Company Name: ___________________________
Address: ___________________________________________________
City:       _____________________    Province/State: _______________
     Postal / Zip Code: __________________   Country: ____________   Fax #: ( _____ ) _____-______
Telephone #: Hm ( _____ ) _____-______  Wk ( _____ ) _____-______ Ext. ____  E-mail: ____________________
Gift Message:___________________________________________________________________________
        (e.g. "To Laura, Happy Birthday!  Love, Mandy") (Gift Message presently available in English only - Gift Message will be hand-printed on a small placard/card only - not a full-sized gift card)

622 Schubert Place NW
Calgary, Alberta   T3L 1X4
Canada
www.CanadianMoose.com

->Calgary & surrounding area:                 Phone: 403.547 - 3118 / Fax: 403.547 - 2564
->Remainder of Canada and the U.S.A.:  Phone (toll free): 1.877.547 - 3118
                                                                       Fax (toll free): 1.877.666 - 7397 (1.877.MOOSE97)
->International:                                            Phone: (Country Code 001) 403.547-3118
                                                                        Fax: (Country Code 001) 403.547-2564
Orders will be processed upon receipt/verification of payment.  Please expect orders to arrive within one (1) to four (4) weeks.  As certain vendors require longer production times, please check on the specific product page to see if your order will take longer to arrive.

Thank you for your patronage.  We hope you enjoy your selection(s)!

AAAAA - VERY, VERY IMPORTANT: SSN (Social Security Number) / EIN (Internal Revenue Service Employer Identification Number) - (for our USA Customers only):
Please click here if you would like more information on the need for the SSN / EIN.
Note: As of June 2005, our Moose Mugs will be shipped from California, USA.  Because of this, CanadianMoose.com will NOT require an SSN / EIN from USA customers who are ordering Moose Mugs.  Enter 'N/A' if your order is for Moose Mugs.  Enter 'N/A' if you are NOT a USA customer.

BBBBB - 'Would Like By' Date: Please let us know if you would like your order by a certain date.  Knowing this ahead of time allows us to request the products quicker from the vendors (although, there is no guarantee that we will receive the products quicker) - WE CANNOT GUARANTEE DELIVERY BY THIS DATE!

CCCCC - 'Cancel If Not Delivered By' Date: If you have filled in this date AND if we feel that we cannot have your order delivered by this date, we will consider your order CANCELLED and it will not be processed.  If you have not filled in this date (i.e. it has been left blank), we will process your order as soon as we possibly can (even if we go past your 'Would Like By' Date).

For definitions of 'Bill To' (Purchaser Information) vs. 'Ship To' addresses, click here.

For Canadian orders, GST will be added (calculated on product + Shipping & Handling costs).

051117/1227-060712/1465-080512/2214-080903/2250
(this is not your Order Number: this is just a 'hit' counter, for us to keep track of 'visits' to this page)