PeepHole Security Dealer Order Form

FAX: 1-888-878-2040

Reference No.

PeepHole Security

PHS -- A Division of Minitronics Canada Ltd

Date

DEALER  INFORMATION
Name                            Dealer Tax. No.
Address
City

  State     Zip Code     Country

Phone*

 Fax  Email * *Required
 

PRODUCT ORDER
QTY

Model/Description

 Color Unit Price Total

UltraVision 56M132

SuperVision 45M132

WideVision 36M132

NuScope 26D301B

ZScope 28D301

EZView 26D503C

EZViewEX 26D507C

MiniScope 14D914

XtraScope 14D214

XtraScope Plus 19D218

EZView2 26D301B

EZViewEX2 26D307B

      SUBTOTAL
PAYMENT Credit Card Information   (US/CAN) S & H
Type* Visa Master   PST
Name* EXP*   GST
Number* Code*   TOTAL

Signature*

 

______________________________   * Required

* Prices in US Fund

(Total may be converted to CND Dollar + handling)

Special Request

Print the completed form, sign and fax back to: 1-888-878-2040