EVAC-U8® Credit Card Order Form

To order your EVAC-U8 Emergency Escape Smokehood:
Please fill out the form below and fax the order form to 1 (604) 523-2691
Please provide the following contact information:
First name Last name
Street address City
State/Province Zip Code
Country Phone
FAX E-mail
Please provide the following ordering information:
PRODUCT NAME QTY
EVAC-U8 Emergency Escape Smokehood US$ 69.95
Quantity of units
Subtotal
Shipping & Handling:
Total
Please bill my credit card:
Credit Card Type
Account name
Card Number
Expiry Date

Thank you for ordering EVAC-U8.