PACE Canada  

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PACE Canada Order Form

Please fill in the form below, print it out, and mail or fax to:

PACE Canada
Canadian Fitness and Lifestyle Research Institute
201-185 Somerset Street West
Ottawa, Ontario
K2P 0J2
CANADA
Fax: (613) 233-5536
Name :
Address:
City:
Province:
Postal Code:
Email:
Phone:
Fax:
No. of kits at $135.00 each, plus 10% shipping:
For a total of:
Kit(s) should be in:
Payment Method:


To pay by credit card please supply the following information:

CARD TYPE:   
CARD NUMBER: (no spaces or dashes)  
CARD EXPIRES:  

___________________________________
[Card-holder's signature]

___________________________________
[Date]


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