PeepHole Security Fax Order Form

FAX: 1-888-878-2040

Reference No.
PeepHole Security

PHS -- A Division of Minitronics Canada Ltd

Date

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CUSTOMER INFORMATION
Name
Address
City

  State     Zip Code     Country

Phone*

 Fax  Email * *Required
 

PRODUCT ORDER
QTY

Model/Description

 Color Unit Price Total

UltraVision 56M132

$

SuperVision 45M132

$

WideScope 27D827C

$

MiniView w/cover 26D825

$

EZView-ST 26D503S

$

EZView 26D503C

$

EZViewXL 26D504C 

$

MiniScope w/cover 14D914C

$

XtraScope w/cover 14D214C

$

XtraScope Plus 19D218

$

UltraVision-A 60M132

$

EZView-LL 27D526C

$

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

Signature*

______________________________   * Required

* Prices are in US Funds. Will be converted to Canadian Funds plus Handling

Special Request

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