Quantum Products
914 Curlew Rd.  Dunedin, Florida  34698
Phone 727-871-5947 Fax 520-844-9674
                                        Call, Fax, Mail or place your order online!                            Date

Bill To

Ship To (If Different from Billing Address):
Name: Name:
Address: Address:
   
City: City
State: Zip code: State: Zip code:
Daytime Phone: Daytime Phone:
Evening Phone: Evening Phone:
E-mail:  

Item Description

Quantity

Price

Total
3x5" Quantum Heat Pack  

$12.50(USD) 

  
5x9" Quantum Heat Pack  

$30.00(USD)

  
6"x18" Quantum Heat Pack  

$50.00(USD)

  
 

 
 

 
 

 
 
   
   
Sub Total  
*Shipping Charges for Orders up to $30.00       $5.00
*Shipping Charges for Orders between $31.00 and $100.00       $10.00
*Shipping Charges for Orders $101.00 and up       $15.00
 GST(8%)       
PST(7%)  
Total  
Credit Card info: Type of Card:  Visa/MasterCard  Card # _____________________________________________    Exp Date _______ 

Name as it appears on card ____________________________      Signature ________________________________ Date _________

Or Mail your cheque or money order to Quantum Products, 914 Curlew Rd.  Dunedin, Florida  34698

 *All shipping and handling prices are for shipments within Canada only.  Please go to  United States section of website for US order form.  All prices and products subject to change without notice.