Kitshop

Regalia Stores Order Form

6 Beechwood Ave., Suite #2
Vanier, Ontario
K1L 8B4

Phone: (613) 744-0222
Fax: (613) 744-0208
E-mail: anavets@storm.ca

UNIT / L.A. / COMMAND NAME:

ADDRESS:

CITY: PROVINCE: POSTAL CODE:

PHONE: ( ) FAX: ( )

DATE OF ORDER: PURCHASE ORDER NO. / NAME:

PLEASE CIRCLE ONE: PLEASERUSH / NO HURRY

DATE REQUIRED:

NOTES:

- Please print this form, fill it out legibly and fax or mail.
- We are working on an e-mail version of this form.