P.O. Box 39574
White Rock, BC V4B 5L6
Phone/Fax: 604-536-8772
Email: velagifts@
shaw.ca 

(Please print and fax to the above fax number)

Name:
Address:
City Postal/Zip:
Phone: State/Prov.
 E-mail: Fax:
Quantity Fragrance/Colour Description Price Total
         
         
         
         
         
         
         
         
         
         
 

Payment Method

Sub Total  
Visa_____ Cheque_____ Cash____

Card #________________________Expiry_______

Name:____________________________________

Signature: ________________________________

Shipping & Handling  
(GST exempt)  
PST  7.5% 
(
Canadian  Residents)
 
Total  
SHIPPING CHARGES: Please contact to enquire about shipping charges for your area