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PINK-SHADED PORTIONS FOR OFFICE USE ONLY
SIMPSONS-SEARS
ORDER FORM
PLEASE SEND YOUR ORDER TO SIMPSONS-SEARS, 6560 DOW AVENUE, SOUT>: BURNABY, BRITISH COLUMBIA
OR TO YOUR NEAREST CATALOGUE SALES OFFICE OR SIMPSON S-SEARS RETAIL STORE
YOUR NAME AND ADDRESS
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PLEASE PRINT CLEARLY
MR. MRS. MISS
INITIAL OR FIRST NAME
LAST NAME
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STREET NO . AND NAME- APT . NO.- R . R . NO.-P.O. BOX NO.
IMPORTANT I
-· ~l_lc__~l---'1-~I-~1~1-~l~l_l~~l~l-~1~l~l---=~1~1:--o-=l=-~l_l_l~~l~l-~I~l~l-~1-
INCLUDE YOUR
POST OFFICE NAME OR CITY OR TOWN AND PROVINCE
TELEPHONE NUMBER
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IF YOU WISH THIS ORDER SHIPPED TO ANOTHER PERSON, DIFFER ENT ADDRESS, FREIGHT OR
EXPRESS STATION, PRINT DETAILS HERE:
/2 1
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IF YOU ARE INCLUDING A
PAYMENT ON YOUR ACCOUNT
PLEASE SHOW THE AMOUNT
ENCLOSED IN THIS SPACE
-----------------------------------------
T/ E
IC01DEll
G/ O
r~Ell
IF YOU HAVE ANY SPECIAL INSTRUCTIONS REGARDING' THIS ORDER, PRINT DETAILS HERE:
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LINE COUNT
ROUTE
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N/ S
IC~E
ACCOUNT
CUSTOMERS
BE SURE TO FILL IN
YOUR ACCOUNT NUMBER
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IN THESE SPACES
YOUR ACCOUNT NUMBER
AMOUNT RECEIVED
$
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PLEASE STATE CAREFULLY; COLOR NUMBER, SIZE AND OTHER INFORMATION REQUIRED.
PLEASE PRINT CLEARLY ANY SPECIAL INSTRUCTIONS FOR A PARTICULAR ITEM ON LINE DIRECTLY BELOW THAT ITEM.
HOW
COLOR
OTHER
PRICE EA.
TOTAL PRICE
DO NOT
CATALOGUE NUMBER
NAME OF ARTICLE
PAGE
SIZE
WRITE IN
MANY
NO.
INFO.
YARD. PR.
$
c
THIS COLUMN
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Post Office C.O.D. charges appear as added postage on mailed
TOTAL OF ORDER
parcels. These charges are: orders of $10.00 and under- $0.50
DO NOT
(order amounts include tax); orders of $10.01 to $99.00-$1.00;
ADD PROV. SALES TAX
SEND
orders of $99.01 or more- $1 .50. Freight and Express companies
CASH
also charge a collection fee on all C.O.D. shipments. C.O.D.
OWING FROM
PREVIOUS ORDER
THROUGH
freight and express orders not shipped to boat or flag stations.
THE
AVOID C.O.D. CHARGES-OPEN AN ALL PURPOSE ACCOUNT
Complete the application form and sign the agreement on the
TOTAL
reverse side of this order form.
~IF
YOU
HAV~IEO
OR
MO~~D
SINCE YOUR LAST
ORDER~
PLEASE PRINT YOUR FOR M ER NAME AND / OR AD DRESS HERE:
AMOUNT OF CHEQUE OR
ti..Js
c
MONEY ORDER ENCLOSED
~L..---~---~~
FOR SHOPPING AT
SIMPSONS-SEARS
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