Order form

Please print and  complete

    Name:
    Adress:
    Town - City:
    Province:
    Postal code:
    Téléphone:   (            )
Quantity Description Total
 

Hard cover book $90.00 each

$
 

CD Rom version $25.00 each

$
 

Complet pack including book and cd-rom $110.00 each

$
  Postal charge if applicable: $10.00 for the book, or $3.00 for the cd-rom $
  Grand total for your order $


Please print and send this form to the following adress including your cheque to:
 

L'Association des Séguin d'Amérique
a/s Gilles Chartrand
1157, rue Laurier
Rockland ON K4K 1J5