ATLANTIC VIOLIN SUPPLIES ORDER FORM
Please complete this form, print it out and fax to: (506) 855-8514

Tel: (506) 858-9886, Toll Free: (866) 575-8130

ATLANTIC VIOLIN SUPPLIES
520 Front Mountain Road
Moncton, NB, Canada, E1G 3H4

Name:
Mailing Address:
Street Address:
City:
Province / State:
Country:
Postal / Zip:
Telephone:
Email:
Item No. Description Price Qty.

Total
$ $
$ $
$ $
$ $
$ $
$ $
Sub Total: $

All catalogue price are in Canadian Dollars.  Applicable taxes and shipping fees are extra.
If you are ordering more than 6 different items, please use additional forms as required and remit as one order.

INTERNATIONAL ORDERS PLEASE NOTE:
Credit card ordering is only offered to North American residents (Canada and USA).
 Only certified checks and Canadian money orders will be accepted on International orders.
(see our order information page for details)

Please select method of payment:

For credit card orders, please enter your card information on the hard copy before sending.
Card Number: _________________________
Name on Card: _________________________
Expiry Date: _________________________
Cardholder's Signature: _________________________