IMPORTANT NOTICE!!
Do not attempt to submit your credit card information online.  This website is not secure, and your privacy and protection cannot guaranteed.  Instead, complete the following form and fax it to (416) 979-8778.

SENDER INFORMATION:
Name:                                                                                                                                                                       
Company:                                                                                                                                                               
Address:                                                                                                                                                                  
City:                                                                        Province:                         Postal Code:                            
Telephone: (         )            -                        Ext.                         Alternate: (         )            -                       
Fax Number: (         )            -                       
E-mail Address:                                                                                                                                                   

DELIVERY INFORMATION:
Name:                                                                                                                                                                       
Company:                                                                                                                                                               
Address:                                                                                                                                                                  
City:                                                                        Province:                         Postal Code:                            
Telephone: (         )            -                        Ext.                         Alternate: (         )            -                       
E-mail Address:                                                                                                                                                   

Include Note Card:          YES             NO
Greeting on Note Card (30 words or less please):                                                                                 
                                                                                                                                                                                     
                                                                                                                                                                                     
                                                                                                                                                                                     
*Delivery Date:                                                                                              
*NOTE: Every effort will be made to deliver your order on the date specified above.  However, due to circumstances beyond our control, delivery times cannot be guaranteed.

How did you hear about us?                                                                                                                           

DETAILS OF ORDER:
Item:                                                                                                                 Price          Qty.              Total

                                                                                                                       $                  x                 = $               
                                                                                                                       $                  x                 = $               
                                                                                                                       $                  x                 = $               
                                                                                                                       $                  x                 = $               
                                                                                                                       $                  x                 = $               
                                                                                                                       $                  x                 = $               
                                                                                                                       $                  x                 = $               
                                                                                                                       $                  x                 = $               
                                                                                                  Shipping: $  8.00     x                 = $               
                                                                                                   Subtotal:                                         = $               
                                                                                                     8% PST:                                         = $               
                                                                                                     6% PST:                                         = $               
                                                                                                         Total:                                         = $               

If applicable, please enter your reference code:                                                                                   
*Note: An adjusted invoice will be sent to you within 2 business days.

PAYMENT OPTIONS:
          Visa             Mastercard
Credit Card Number:                                                                                                                                         
Expiry Date:                                    
Name on Credit Card:                                                                                                                                        

Signature of Cardholder:                                                                                                                                 

*An official receipt will be mailed to the sender at the address specified above once payment has been processed.
**In the event that the total listed above is miscalculated, JustLyds Elegance reserves the right to make the appropriate corrections.  If the calculated difference is greater than 10% of the estimated total, you will be contacted before your credit card is processed.

Thank you for your business!