BILL TO: (Please print) School/ Institution (if applicable) Contact Name Address/P.O. Box City Prov. Postal Code Telephone ( ) Email SHIP TO: (Please print) School/ Institution (if applicable) Contact Name Street Address City Prov. Postal Code Telephone ( ) Email 3075 Line 8, RR2 Bradford, ON L3Z 3R5 Toll Free 1-800-268-1268 Fax Free 1-800-567-8054 Unit Extended Qty. Item # Colour Name of Item - Description Each Price Add 15% Shipping & Handling If you need more space, please use the back of this form. Date Total this side: $ ___________ + Total other side: $ ___________ Merchandise Total Subtotal (Incl. Merchandise Total & Shipping & Handling) HST or GST PST or QST where applicable Qty. Item # Gift Card Redemption: $ _________ Card #: ________________________________ (Subtract Card Amount from Subtotal) Subtotal Subtotal TOTAL Gift Card Phone Toll Free 1-800-268-1268 Fax Toll Free 1-800-567-8054 Online www.WINTERGREEN.ca TO ORDER Ordering a Gift Card? Place your order here! *Quebec Residents: QST is calculated on the Subtotal + the GST Card # / / / Expiration Date / Signature } All orders from individuals must be accompanied by payment, or credit card information. PAYMENT METHOD Cheque Enclosed VISA® MasterCard® American Express® Charge Our Account Authorized Purchase Order # Account # (if known) Promo Code (if applicable) 2019 Order Form