CANADIAN INTERNATIONAL DRUG AWARENESS CENTRE
A Non-profit Organization   (Print this form, fill it in and mail to address below)
__________________________________________________________________________
Invoice/Order form(Canada)                                                 " The Self-Destructive Use of Drugs"
                                                                                                      Drug Awareness Poster
Yes, I'd like to make a difference                                          Date:________________________

Contact Person:______________________________________________________________
Company or Organization:____________________________________________________
Mailing Address:___________________________________________________________
City/Town:_______________________________________________________________
Province:_______________________________________________________________
Postal Code:___________________________________________________________
Tel.No:___________________________________________________________________
Certificate of Recognition
A certificate of recognition will be issued with each order placed. Please print clearly the name that
is to appear on the Certificate
Name:___________________________________________________________________
Order information
Send _____ copies of "The Self Destructive Use of Drugs"poster(s)
________English, _______French____________
Full colour 19"x28" double-laminated, printed on heavy duty coated card stock
                                                                                Quantity          Unit Cost          Total
     Terms
- payment due upon receipt of invoice                        1 - 4                $39.95         ______
- 30 days full money back guarantee
    Payment Method
______Money Order
______Cheque

                                                                                 Shipping and Handling              7.50
                                                                                 Subtotal                                 ______
                                                                                 Plus 7% gst                            ______
                                                                                 Plus 8%pst                             ______
Allow 2 to 3 weeks for delivery                                  Total Due                              _______
Signature:___________________________________________________________________
Please make cheque or money order
payable to: Authorised distributor                                    Rosemin Karmali
                                                     6352 Viseneau drive\,Orleans, Ontario.
                                                     K1C 2L4