Fill out this form and mail to address below

Organization:
Fire Department Name:
Contact Name:
Address 1:
Address 2:
Phone:
E-Mail:
Web-Site:

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Product Packages	Description	Price	Order ?
Bronze	English	$1,895.00	Yes	No
	Spanish	$1,895.00	Yes	No
	English and Spanish	$2,495.00	Yes	No
Silver	English	$1,895.00	Yes	No
	Spanish	$1,895.00	Yes	No
	English and Spanish	$2,495.00	Yes	No
Gold	English	$1,995.00	Yes	No
	Spanish	$1,995.00	Yes	No
	English and Spanish	$2,595.00	Yes	No
	Grand Total:

Payable to: Online P2000
71 John Walter Cres, Courtice, ON, L1E 2W7, Canada

For all packages, please attach a 3.5" diskette with a copy of your fire department patch along with your order. Save as Type JPEG(*.jpg)