LAZY DAISY ORDER FORM  

Name
Phone
FAX
E-mail

    Ordering Information:

When choosing a color, please include a first and second choice.

                                                   Sub Total.........................       

                                                    Canadian Res. add 7% GST 

                                                     Ontario Res. add 8% PST    

                                           TOTAL........................       

            Shipping cost will be added to your order.                                                                                                                                     We ship by Canpar or Parcel Post (whichever is cheapest).                                                                                                

 

	BILLING
	We  Accept VISA and MasterCard
Cardholder Name
Card Number
Expiration Date

You may fax the VISA information to 705-684-8800

	SHIPPING
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country

If you have any problems please contact us at lazydaisy@vianet.ca

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PLEASE NOTE:  We are experiencing problems with the submit button.  It will show "Page Error" but in fact your order will go through.  We will e-mail you to confirm receipt of your order.