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6.7.9.8.2 Irie Pascal (Universal Edition) CA$ Order Form

No. UsersUnit PriceQuantityAmount
    1   159.95________$_____________
    5   639.95________$_____________
   10 1,199.95________$_____________
   20 2,199.95________$_____________
   40 3,899.95________$_____________
  100 6,399.95________$_____________
Shipping
& Handling     8.00$_____________
TOTAL$_____________

[  ] Check/Money Order enclosed

Name:_______________________________________________________

Address:____________________________________________________

City/State/Province:________________________________________

Country/Postal Code:________________________________________

Telephone:_______________________________________ [optional]

Email Address:___________________________________ [optional]

How did you hear about Irie Pascal?_________________________

_________________________________________________ [optional]

[  ] Tick this box to join the Irie Pascal mailing list.

Please do not send cash. Make checks or money orders payable to Irie Tools. All prices are quoted in CA$ and are guaranteed until March 31, 2004. Please allow two to four weeks for delivery. If you fill in your email address you will be notified by email when your order is shipped.

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