| PH: 250-390-3344 | |
| FAX: 250-390-4453 | BOX
99, LANTZVILLE |
| E-MAIL: sales@norseloghomes.com | BRITISH
COLUMBIA |
| WEB SITE: www.norseloghomes.com | CANADA,
V0R 2H0 |
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I would like to order __ log home plan catalog(s) at $15.00 US each.
..
(Includes shipping and handling)
Visa / MasterCard Charge Authorization Release
**Please enter information exactly as shown on card**
I, _________________________________ authorize “Norse Log Homes Ltd.”
to charge $_______________
to my oVisa
oMasterCard
Account
#: Expiry Date:
Date:
_________________
Signature:
_________________
name:_____________________________________
address:____________________
city: ______________ province/state:
___
postal
code/zip code _________ country: ______________
phone:
(__) ___________ e-mail: ____________________
Please print and fill out this form and fax to (250) 390-4453
or mail to the address at the top of this page.
Thank-You