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Qty. Item Name of Item - Description Price Each Extended PriceNumber Easy Order Form Bill To Contact ___________________________________________________________________ SchoolInstitution _____________________________________________________ Address ___________________________________________________________________ City ________________________________________________________________________ Prov. ______________ Postal Code _________________________________ Phone _____________________________________________________________________ Email ______________________________________________________________________ Ship To If different from Bill To Contact ___________________________________________________________________ SchoolInstitution _____________________________________________________ Address ___________________________________________________________________ City ________________________________________________________________________ Prov. ______________ Postal Code _________________________________ Phone _____________________________________________________________________ Email ______________________________________________________________________ PrincipalDirectors Name _____________________________________________________________________________________________________________________________ 3075 Line 8 RR 2 Bradford ON L3Z 2A5 Phone Free 1-800-268-1268 Fax Free 1-800-567-8054 www.WINTERGREEN.ca PAYMENT METHOD All orders from individuals must be accompanied by payment or credit card information. Cheque Enclosed VISA MasterCard American Express Charge our account Authorized Purchase Order Account if known Card Expiration Date Signature Quebec Residents QST is calculated on the Subtotal the GST Promo Code if applicable Subtotal Incl. Merchandise Total Shipping Handling Add 15 Shipping Handling HST or GST PST or QST where applicable Subtotal Incl. Subtotal Taxes Total Gift Card Redemption _________ Card ______________________________ Subtract Card Amount from Subtotal Merchandise Total DD624 22.5H Small Straight Panel - 20W 22.5H 239.95 DD626 22.5H Large Straight Panel - 33W 22.5H 299.95 DD625 30H Small Straight Panel - 20W 30H 279.95 DD627 30H Large Straight Panel - 33W 30H 329.95 DD629 Small Wave Panel 299.95 DD642 Medium Wave Panel 314.95 DD640 Large Wave Panel 329.95 DD630 Safety Gate 579.95 DD641 Extra-Wide Safety Gate 659.95 DD634 Connector - 18.5 34.95 DD635 Connector - 22.5 36.95 DD637 Connector - 30 42.95 DD631 Wall Adaptor - 22.5 46.95 DD632 Wall Adaptor - 30 49.95 DD623 Preschool Archway 299.95 DD622 Toddler Archway 279.95 DD615 Play-Top Connective Storage Unit 709.95 DD620 Connectable Preschool Low Storage Unit-Assembled - 22.5H 489.95 DD621 Connectable Preschool Storage Unit-Assembled - 30H 559.95