Fax Form

Personal Information

First and Last Name:

_________________________________________________

Street Address:

_________________________________________________

City:

_________________________________________________

Province/State:

_________________________________________________

Postal Code/Zip Code:

_________________________________________________

Telephone Number and Area Code:

_________________________________________________

Email:

_________________________________________________

Payment:

Visa

MC

Amex

Certified Cheque

Money Order

*Note: All payments made via Certified Cheque or Money Orders should be made payable to Cupstuff.

Credit Card Number:

_________________________________________________

Credit Card Expiry Date:

_______________

Order Information

Item Description

Size

Team

Quantity

Price per Item

Total

Sub Total

HST 13%
(Nfld., Ont. and NB Residents only)

HST 15%
(Nova Scotia Residents only)

GST 5%
(Residents of Canada except B.C., Ont., Nfld., NS, and NB)

HST 12%
(Residents of British Columbia only)

Shipping
(If paying in US currency $8.99 or $8.99 in CDN currency)

Grand Total

Corporate Information

Cupstuff
91 Rylander Boulevard,
Suite 7-244
Toronto, Ontario, Canada
M1B 5M5

Tel.: 1-877-CUPSTUF (287-7883) or (905)939-2833
Fax: (905) 939-7152
Email: wecare@cupstuff.com