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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, SOUTH BURNABY, BRITISH COLUMBIA
OR TO YOUR NEAREST CATALOGUE SALES OFFICE OR SIMPSONS-SEARS RETAIL STORE
YOUR NAME AND ADDRESS
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PLEASE PRINT CLEARLY
MR. MRS. MISS
INITIAL OR Fl RST NAME
LAST NAME
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STREET NO. AND NAME- APT . NO.-R . R . NO.-P.0 . BOX NO .
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IMPORTANT
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INCLUDE YOUR
TELEPHONE NUMBER
POST OFFICE NAME OR CITY OR TOWN AND PROVINCE
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IF YOU WISH THIS ORDER SHIPPED TO ANOTHER PERSON, DIFFERENT ADDRESS, FREIGHT OR
EXPRESS STATION, PRINT DETAILS HERE:
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T/ E
rO,DEll
G / O
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IF YOU HAVE ANY SPECIAL INSTRUCTIONS REGARDING THIS ORDER, PRINT D ETAILS HERE:
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LINE COUNT
ROUTE
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N/ S
r~E
IF YOU ARE INCLUDING A
PAYMENT ON Y OUR ACCOUNT
PLEASE SHOW THE AMOUNT
ENCLOSED IN TH IS SPACE
ACCOUNT
CUSTOMERS
BE SURE TO FILL IN
YOUR ACCOUNT NUMBER
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IN THESE SPACES
YOUR ACCOUNT NUMBER
AMOUNT R ECEIVED
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$
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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- $1.50. Freight and Express companies
CASH
OWING FROM
also charge a collection fee on all C.0.0. shipments. C.O.D.
PREVIOUS ORDER
TH ROUGH
freight and express orders not shipped to boat or flag stations.
THE
AVOID C.0.0. CHARGES-OPEN AN ALL PURPOSE ACCOUNT
Complete the application form and sign the agreement on the
TOTAL
reverse side of this order form.
~OU HAVE~RRIED
OR MOVED
S~R
LAST ORDER, PLEASE PRINT YOUR FORMER NAME ANO / OR ADD RESS HERE:
AMOUNT OF CHEQUE OR ....
1$
C
MONEY ORDER
ENCLOSED ,.. ~
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FOR SHOPPING AT
SIMPSONS-SEARS
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