Canadian Order Form Company NamePhone*Attention*Email* Select Your Product To See Pricing and Quantities CYG Germination Pouch Large CYG Germination Pouch High-Contrast Blue Blotter Germination Pouch Additional Polypap Stands CYG Germination Case of Pouches Price: $450.00 Quantity: 1000 pouches per case and two polypap standsCYG Germination Pouches Price: $65.00 Quantity: Sets of 100 pouchesNumber of Additional Polypap Stands Price: $4.00 Quantity: *When ordered separately, a minimum of 5 stands is required. High-Contrast Blue Blotter Germination Case of Pouches Price: $389.00 Quantity: 500 pouches per case and two polypap standsHigh-Contrast Blue Blotter Germination Pouches Price: $109.00 Quantity: Sets of 100 pouchesCYG Germination Large Pouches Price: $129.00 Quantity: Sets of 100 pouchesCYG Germination Case of Large Pouches Price: $422.00 Quantity: Sets of 500 pouchesTotal $0.00 All prices are in US Dollars.Purchase Order Numberif necessaryBilling Address Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland & LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Shipping Address Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland & LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Shipping*Ship to Billing AddressEnter Separate Shipping AddressSpecial Delivery InstructionsCustoms or Forwarding Agent InformationBN/NEForeign orders may be subject to import duty. Customer will be responsible for such charges. Yes, I would like to pay by credit cardOrders of $200 or less need to be paid by credit card.Card Type*VisaMastercard*Card Number*Cardholder Name*MonthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember*Year20142015201620172018201920202021202220232024202520262027202820292030*CCVCredit Card Billing Address*Same as Billing AddressSame as Shipping AddressOther (enter new address)Credit Card Billing Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSaint MartinSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country NameThis field is for validation purposes and should be left unchanged.
