Name:
Address:
City: Province/State:
Country: Postal/Zip:
E-mail (optional)
I would like KozaK AutoDryWash Cloth(s) at a cost of $16 CDN/ $11 USD (please circle one) each for a total of ____ CDN$/USD (please circle one). Prices include shipping. Canadian price also includes applicable taxes.
Mail this form with payment to:
Allan Lewis Enterprises
449479 Tenth Line
RR#2, Singhampton, Ontario
Canada, N0C-1M0
Please make cheques or money orders payable to Allan Lewis.
Your order will be shipped within one business day but please allow 1 to 4 weeks for delivery by the Post Office.
Thank You!