CTA Order Form

ORDER FORM

Orders can be made by Email or Fax.

Shipping Address (No PO Boxes, Please)

Name ________________________________________
Address ______________________________________
_____________________________________________
City ___________ State/Prov. _______ZIP __________
Country ______________________________________
Phone _________________

E-Mail _________________

Contact Information

CW Technical Services
4 Cousins Court
Brampton, Ontario L6Y 3K6

Canada
Ph: (905) 487 0236

Fax: (905) 796 2820

Vehicle Information

Year

Make

Model

Engine

Quantity

Part Description

Part No. (if applicable)

Unit Price

Shipping And Handling
Sub Total
GST (Canadian Residents Only)
PST (Ontario Residents Only)
Total

Please Indicate Method Of Payment

Certified Cheque

Money Order (International)

Credit Card

(PayPal only)

Customer Signature:

Please write Cheques or Money Orders payable to:

CW Technical Services
4 Cousins Court
Brampton, Ontario L6Y 3K6

Canada
Ph: (905) 487 0236

Fax: (905) 796 2820

There is a 3 day approval period for certified cheques and money orders, 5 day approval period for personal cheques.