To print out this form, press CTRL-P or go to the File menu and choose Print.
Mar-Lift Order Form
Phone:
1-877-892-0901 (toll free)
613-692-4181 - Day 613-692-2794 - Evenings
Fax:
613-692-0760
Address:
Majestic Auto
Kars ON K0A 2E0
CANADA
Make checks payable to: Majestic Auto.
Items Ordered
Brake Winch Mar-Lift:
(available in different colors)
Wheel Kits with Lock:
1/2 Mar-Lift:
(available in black only)
Wheeled Dollie:
(available in black only)
Currency:
Canadian
U.S.
Brake Winch Mar-Lift Color:
Yellow
Blue
Red
Black
Shipping:
Ontario
Quebec
Maritimes (Not NFLD)
Manitoba
Saskatchewan
Alberta
British Columbia
USA
*
- Fields that must be filled out.
Name and Address
*
Name:
*
Address:
Shipping Address:
(if different than address)
Phone Number:
(Day time)
Phone Number:
(Night time)
*
City:
*
State/Province:
*
Zip Code/ Postal Code:
Method of Payment:
Credit Card
Check (Cheque)
Money Order
Type of Card:
VISA
MasterCard
AMEX
Credit Card Number:
Expiry Date:
(mm/yy)
Cardholder's Name: