Order Information

Address

 Purchaser: ________________________________________________________
 Telephone: ________________________________________________________
 Address: __________________________________________________________
          __________________________________________________________
          __________________________________________________________

 Shipping Address (If different)
 
 Name:  ____________________________________________________________
 Address: __________________________________________________________
          __________________________________________________________
          __________________________________________________________

  Qty. Item # Description                        Unit Price    Total
  ___ _______ __________________________________ __________ ________
  ___ _______ __________________________________ __________ ________
  ___ _______ __________________________________ __________ ________
  ___ _______ __________________________________ __________ ________
  ___ _______ __________________________________ __________ ________
  ___ _______ __________________________________ __________ ________

 Payment Method  
 [__] Personal or Company Checks made out to "M.F. Kelly Ltd."
 [__] Money Order,
      [__] VISA        [__] MasterCard
    Credit Card Number: ____________________________________________
    Expiration Date:  _______________
    Name of Issuing Bank: __________________________________________
    Signature:  ____________________________________________________

Payment Calculations

Sub Total    : $_________  Enter total for all items ordered here.
Shipping &                 
Handling     : $_________                          
Sales Tax    : $_________  (HST @ 15% Nfld & Maritime Provinces only)
                           (GST @ 7% For the remainder of Canada) 
===========================
 TOTAL COST  : $_________