O R D E R   F O R M

 
Name:
Address Line 1:
Address Line 2:
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How Many Bears:
(24.00 each CDN/USD includes taxes)

+ Shipping will apply in most areas
NB: Shipments to the USA valued over $200.00 may require IRS #'s
Please inquire about our shipping rates at: hyjmas@sympatico.ca
Make Check or money order payable to:
10-4 Teddy Bear Wheelchair Foundation
1240 Maple Ridge,
Saint-Lazare, Quebec, Canada
J7T 2K9