Ozone Services Purchase Order Fax Form

 Quantity                                 Product                             Price
 ========        ========================================================   ==========

   ____          ________________________________________________________   __________

   ____          ________________________________________________________   __________

   ____          ________________________________________________________   __________

   ____          ________________________________________________________   __________

   ____          ________________________________________________________   __________

   ____          ________________________________________________________   __________

                             S&H as quoted by Ozone Services   ________

                                                                   TOTAL:   __________

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 Billing Name:  ____________________________________________________________________________

      Address:  ____________________________________________________________________________

         City:  ___________________________  State: ___________________ Zip: _______________

     Phone No:  ___________________________  Email Address:  _______________________________

       Fax No:  ___________________________  

Shipping Name:  ____________________________________________________________________________

     Address:  ____________________________________________________________________________

        City:  ___________________________  State: ___________________ Zip: _______________

    Phone No:  ___________________________  Email Address:  _______________________________

      Fax No:  ___________________________  


Payment Method:  ___Visa  ___Mastercard  ___Discovery  ___Money Order  ___Personal Cheque

Credit Card No:  _________________________________   Expiry Date:  __________

Name on Credit Card:  _______________________________________________________

I understand that by completing and signing this form, that Ozone Services will debit my 
credit card for the total amount indicated in U.S. Dollars plus applicable S & H charges.


Date:      ________________________________  Signature: ____________________________________

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US Customs requires the following for all shipments valued over 1200U$ entering USA:

 Businesses - Tax Identification No: _______________________________________________________  

 Individuals - Social Security No:   _______________________________________________________ 

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If you are using your credit card, please email this form to Ozone Services.

If you are not using a credit card, please Postal Mail this form with your CERTIFIED 
personal cheque or money order to (DO NOT SEND CASH):

Ozone Services, 125 Willow Ridge Manor SW, Black Diamond, AB, T0L 0H0, Canada

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Please feel free to add a second page for your suggestions or comments!