Date:     _____________________

To:  Red Maple Connection          Fax #:     613-962-1485 (Canada)

       Phone # : 613-961-0668 (Canada) 

PLEASE PRINT:

1. Name: _________________________

2. Address: ______________________________________________________________

3. Phone #: ___________________  Fax # :  ________________________  

4. E-mail Address: _________________________________

5. Product code (Your first choice): __________________________________ 
    Discount Price if it's on sale (confirmation purpose): __________________

6. Your second choice product code if the first choice was sold: ____________
    Discount Price if it's on sale (confirmation purpose): _____________________

7. If you buy two, 5% off for both, and if you buy three, 10% off for all. 
    Product code for the second one : ________  Discount price if it's on sale : _______
    Product code for the third one :  __________ Discount price if it's on sale : _______
8. Method of payment.  __________________________
   (Money Order or Bank Draft / International Wire Transfers)
9. If this is a gift:  

   Gift for : Mr. Mrs. Miss Ms.  ____________________________________
   Ship to : Address: _______________________________________________________
   Phone # : _______________________

Please feel free to write us if you have any questions, concerns, any information such as direction of delivery date, daytime phone, cell phone, and so on.