Mail Order Form

Please type in the following information before printing this form.
Use the Tab key or mouse to move to each item.
Bold items are required, others are optional.

Full name:
Address:

Country:    Postcode/Zip:
E-mail:
Telephone: ()
Product:   x  Qty:  

Payment (payable to GoldWave Inc.):
Check enclosed
Purchase Order enclosed
International Money Order or Draft enclosed
International Money Order sent separately
Notes:
(5 lines
or less)
Please mail this form to the address below.
Thank you for purchasing!

GoldWave Inc.
P.O. Box 51
St. John's, NL
CANADA A1C 5H5

www.goldwave.com