Order Form Order Form
Asphalt Test Report System
Date: _________________
To: From: McIntyre Associates 233 Marine Drive Cobble Hill, BC V0R 1L1 Canada Tel: 250-743-7212 Fax: 250-743-7553 Email: McIntyreAssociates@shaw.ca 1) Select One:
Cheque is Enclosed
2) Specify Components (separate order required for each physical site):
Description CA$ US$ Total Asphalt Test Report System (without PDF/Email) 750 750 Optional PDF Generation & Email Feature - Add-on 200 200 Sub Total GST (Canadian residents – except BC, NB, NFL, ON, NS) 5% HST (Canadian residents of BC) 12% HST (Canadian residents of NB, NFL, ON) 13% HST (Canadian residents of NS) 15% International Bank Transfer (if applicable) 20 Total Order Indicate currency 3) If you elect to pay by International Bank Transfer, please include the US$20 charge in your order. We will send you our bank details along with our invoice.
4) If you send a cheque in US$, then it must be from a US or Canadian bank. We also can accept cheques from many other countries, at the current exchange rate. Please contact us for a quote.
5) Please indicate how you would like your license identified. Use your organization’s name and physical location:
License Holder: _______________________________________________
Physical Location: _______________________________________________
6) Specify a contact name and e-mail address for us to send your registration serial number and for system update notices. (We will never use this data for any other purpose, or give it to anyone else.)
Contact: _______________________________________________
Email Address: _______________________________________________