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Quick Shop Form

Use this form as a quick way to get your order through to us. If you are not picky as to
what brand you use or just don't want to use our virtual shopping cart you can use a
freeform list of items you want and our shopper will pick the best possible products
to match your list.

You can print it out and fax it to us at (604) 932-3243 or click the "Submit Order" button at the
bottom of the form to automatically have it e-mailed to us.

This form is fully secure using SSL encryption technology to scrample the credit card data going over the internet.

Note: Delivery charge is $25.00 on each order.

Shopping List:



Enter each item on a separate line.


Example:
12 Eggs,
1 Loaf of whole wheat,
2L Milk, etc...
Name:

First                 Last
E-Mail

Example: john@hotmail.com
Phone Number:

Example: (555) 555-5555
Tour/Vacation Company:

Other:
Delivery Address:

Example: 232 Par Rd. Unit 32
or
Holiday Inn Room # 233
Special Instructions
Delivery Date:
/ /

Delivery Time: :
(e.g. 10:30am)

 

 

 

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