Canadian Order Form Company NamePhone*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 Pouch100 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 $0.00 All prices are in US Dollars.Purchase Order Numberif 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 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*VisaMastercardAmerican Express*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 AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country NameThis field is for validation purposes and should be left unchanged.
