A1 Electronic Parts
196 North Queen St.
Toronto, Ontario
M9C 4Y1
Tel: (416) 255-0343
Fax: (416) 255-4617


Date: ________________

FAX to 416 255 4617 or mail to A-1 Electronic Parts at 196 North Queen St., Toronto ON, Canada M9C 4Y1



POSTAL/ZIP___________PHONE:                                E-MAIL:                                                                            

Quantity Order Code Description Price Total
UPS ACCOUNT#:                           |  FEDEX ACCOUNT#:                          
Orders over 2 lb, please call or email for shipping quote.



This is to certify that I am over the age of 16 and wish to purchase the products you have advertised.  I hereby authorize A-1 Electronic Parts to debit my credit card for the amount of this order. Signature:__________________________________ GST (5%)  
PST (8%)  
Card #                                                                    EXP. DATE      Shipping:
Signature__________________________ Total: $