ORDER FORM

 Click on Submit when ready to send.

* - Required Fields

*Your name:

*Email address:

*Address:

*City: *Province/State:

*Postal/Zip: *Country:

*Phone (important):

 

Credit Card #: Exp. Card Type:

If you wish to phone in credit card number check this box:

 

 

 Order Code

 Description
  Quantity

x

 Price

=

 Total
 

x
  $

=
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x
  $

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x
  $

=
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x
  $

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x
  $

=
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x
  $

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x
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x
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  • U.S $14.90 Canada $9.99
    for Shipping up to 2 lb.
  • Orders over 2 lb, please call or email for shipping quote.
   $

 
          Subtotal:

 =
 $
         Add 7% GST:

 =
 $
         Add 8% PST (Ontario Residents Only):

 =
 $
         *Grand Total:

 =
 $

I agree to the following:

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.

Yes