BOOM PLUS TOYS
Order Form

www.boomplustoys.net
Fax Number: (604) 325 - 8382

PLEASE PRINT AND COMPLETE THE FOLLOWING CLEARLY IN FULL THEN FAX

Payment Method (please circle):
Visa
MasterCard

CC Number: Expiry Date:

Cardholder Name (exact on card):

Authorization Number (3 digit numbers on back of card):

Address:

City: Province/State:

Postal/Zip Code Country:

Home / Work Phone Number (with area code):
Cell Phone Number (with area code):

E-mail Address (must be valid):

Social Security Number (SSN):
* For custom clearance procedures to the USA
Quantity
Product Description
Car Model
Amount Listed
       
       
       
       
       

Sub-Total:  
Shipping Cost (E-mail us for quotes):  
6% GST (Only Canadian Residence):  
7% PST (Only B.C. Residence):  
Insurance:  
GRAND TOTAL:  
* Note: If insurance is not purchased, coverage will only cover maximum of $75USD / $100CAD

By signing this form, I agree to the terms and conditions set forth by Boom Plus Toys Ltd. as listed on the purchasing page of www.boomplustoys.net. In addition, I authorize Boom Plus Toys Ltd. to charge my credit card listed here for the grand total of ____________________________ in full for the products listed above.

Cardholder Signature: Date: