Coast Rocketry Order Form

 20230  42nd  Ave, Langley B.C. Canada. V3A 3A5     Phone (604) 530-5411   or    Fax (604) 530-7447.  

Print out this page and mail or fax it to Coast Rocketry. All order information will be kept in confidence for Coast Rocketry and will not be passed on to any other parties. Coast Rocketry will calculate all applicable taxes and shipping charges and will then contact you, usually by phone for your approval. Orders may be paid by PayPal, credit card or money orders and are normally shipped next working day. 

Name: First:                                                          Last:                                                                            Email (required for PayPal)                 :                     

Home Address (required if not a business):     Street:                                                                         City:                                     

 Province / State:                                                     Postal Code / Zip:

Phone numbers including area code:    Home  (required if not a business):                                                   Business: 

Shipping Address if Different                Street:                                                                         City:                                     

 Province / State:                                                     Postal Code / Zip:

Quantity

Item Number

Description

Unit Price

Total

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 Coast Rocketry will add all applicable taxes and shipping charges and will then contact you, usually by phone for your approval.

Sub Total

$

Payment Method:     (please circle one)      PayPal     /    Visa   /    MasterCard   /    Money Order             

Full Card Number:    ____________ - ____________ -  ____________ - ____________  Expiry Date: month ___________ year  20 _____________

Send e mail to Coast Rocketry with questions or comments about this web site.