Canadian Order Form "*" indicates required fields Company Name Phone* Attention* Email* Select Your Product To See Pricing and Quantities CYG Germination Pouch Large Seed CYG Germination Pouches Long High-Contrast Blue Blotter Germination Pouch Additional Polypap Stands Bamboo Stand CYG Germination PouchCYG Germination Pouches Price: $65.00 Quantity: Sets of 100 pouches. Stands sold separately.CYG Germination Case of Pouches Price: $450.00 Quantity: 1000 pouches per case and two polypap standsLarge Seed CYG Germination PouchesLarge Seed CYG Germination Pouches Price: $129.00 Quantity: Sets of 100 pouchesCase of Large Seed CYG Germination Pouches Price: $422.00 Quantity: Sets of 500 pouchesLong High-Contrast Blue Blotter Germination PouchLong High-Contrast Blue Blotter Germination Pouch 100 Pouches Price: $130.00 Quantity: 250 Pouches Price: $305.00 Quantity: 500 Pouches Price: $585.00 Quantity: Additional Polypap StandsNot suitable for use with the Large Seed or Long Blue Blotter PouchesNumber of Additional Polypap Stands Price: $4.00 Quantity: *When ordered separately, a minimum of 5 stands is required. Bamboo StandsNumber of Bamboo Stands Price: $16.00 Quantity: Total All prices are in US Dollars.The Polypap Stand is recommended for use with this product.The Bamboo Stand is recommended for use with this product.Purchase Order Number if necessaryBilling Address Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Shipping Address Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Residential Check here if this is a residential address. Shipping* Ship to Billing Address Enter Separate Shipping Address Special Delivery InstructionsCustoms or Forwarding Agent InformationBN/NE Foreign orders may be subject to import duty. Customer will be responsible for such charges. Orders of $200 or less need to be paid by credit card. Yes, I would like to pay by credit card Orders of $200 or less need to be paid by credit card.Please review your order because we do not accept returns or exchanges.Card Type*VisaMastercardAmerican ExpressCard Number* Card NumberCardholder Name* Cardholder Name*MonthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember*Year20202021202220232024202520262027202820292030CCV* CCVCredit Card Billing Address* Same as Billing Address Same as Shipping Address Other (enter new address) Credit Card Billing Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country EmailThis field is for validation purposes and should be left unchanged. Δ
