REDLINE

44 Menard Street, Embrun, Ontario, Canada K0A 1W1 P.O. Box 307, Massena, New York, USA 13662-0307

ORDER FORM

Name:	Date:
Tel #: (home) (bus)	Fax #:
Street Address:	Apt. #:
City:	Province/State:
Country:	Postal/Zip Code:
Product: q Eliminator - $39.95 USD each + S&H q Laser Shield - $29.95 USD each + S&H q Photo Radar Spray (8 oz) - $29.95 USD each + S&H q Photo Radar Spray (2 oz) - $19.95 USD each + S&H	Quantity: q Eliminator ___________________ unit(s) q Laser Shield _________________ unit(s) q Photo Radar Spray (8 oz) _______ unit(s) q Photo Radar Spray (2 oz) _______ unit(s)
IMPORTANT: For orders outside of USA and Canada, complete the following information about your country’s license plate. q Height: q Length: q Height in centimetres for the numbers on the license plate: q Distance in centimetres from the bottom edge of the plate to the bottom edge of the numbers: q Indicate number of mounting holes required: q Indicate in centimetres the distance mounting holes are from corners of plate:
Method of Payment: q Visa q Mastercard q American Express Card # _________________________ Expiry date _____________________ Signature* ______________________	Method of Shipment: q First Class Postal q Express Postal q Priority Courier q Standard Courier q Courier Collect Account # ________________ *Note: I hereby authorize Redline to charge this sale to my credit card. This form shall be deemed as the Sales Draft.

Telephone 613-443-1303 Fax 613-443-0529 www.redlineauto.com