Splashes From The River Inc.
COZY EDUCATIONAL PRODUCTS - Canadian ORDER FORM
(prices listed are in Canadian dollars)

Print form and Fax to:1-250-286-4543
Or Mail to: Splashes From The River Inc. 633 Birch Street  Campbell River, BC  CANADA V9W 2T2
                     Phone: 1-800-201-2280     Fax: 1-250-286-4543 

Cheque or Money Order enclosed ____Visa ____Mastercard ___ AMEX ___

Credit card number __________________________Expiry date __________

Name as it appears on my card: _______________________________

Please send my order to: (NAME)________________________________________

ADDRESS: ___________________________________________________________

CITY: ____________________________________PROVINCE _____POSTAL CODE:____________

PHONE: _________________________  E-MAIL: ________________________

(please provide E-mail address if you wish to receive confirmation when your order is shipped)