Order Form for FCPC Publications

Mail: Heather Spencer, FCPC, 885 Don Mills Rd., Suite 301, Toronto, ON M3C 1V9
Fax: (416) 510-8043

Qty Title Unit Price Total
       
       
       
       
       
       
       
   Sub Total  
 S & H  $15.00
 5% GST  
 Total  
Method of Payment:
By Cheque payable to FCPC: [   ] Enclosed   [   ] To follow   [   ] Please invoice
By Credit Card: [   ] VISA   [   ] MasterCard   [   ] American Express
Card #: _______ _______ _______   Expiry Date: ____ / ____
Name on Card: ____________________________________________
Signature: ____________________________________________
Customer Information:
Name: _______________________________________________________
Company: _______________________________________________________
Address: _______________________________________________________
City: ________________________  Province: ________
Postal Code: ________  ________
Phone: (      ) _______ - _________
Fax: (      ) _______ - _________      Email: _________________________