b'Date 2023 Order FormTO ORDER3075 Line 8, RR2 Phone Toll Free 1-800-268-1268Bradford, ONL3Z 3R5Toll Free 1-800-268-1268 Fax Toll Free 1-800-567-8054Fax Free 1-800-567-8054 Online www.WINTERGREEN.caBILL TO: (Please print) SHIP TO: (Please print)School/ School/Institution (if applicable) Institution (if applicable)Contact Name Contact NameAddress/P.O. Box Street AddressCity CityProv. Postal Code Prov.Postal CodeTelephone () Telephone ()Email Email Unit ExtendedQty. Item # Colour Name of Item - Description EachPriceMore space on the back of this form. For orders under $66 (before tax), a minimum freight charge of $9.95 will be added.Total this side: $ ___________ +Total other side: $ ___________Merchandise TotalPromo Code (if applicable) Add 15% Shipping & HandlingSubtotalPAYMENT METHOD All orders from individuals must be accompanied by(Incl. Merchandise Total & Shipping & Handling)payment, or credit card information.Cheque Enclosed HST or GSTVISA} Card # / / / PST or QST where applicableMasterCard Expiration Date/American Express Signature SubtotalCharge Our Account Authorized Purchase Order # Gift Card Redemption: $ _________ Account # (if known) Card #: ________________________________(Subtract Card Amount from Subtotal)Qty. Item # SubtotalOrdering a Gift Card?Gift CardPlace your order here!TOTAL*Quebec Residents: QST is calculated on the Subtotal + the GST'