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KroTek Electronics Cheque Order Form Banner Image

This order form is included for your convenience if ordering by check. Just print it out, fill it in, and send it along with your check to:

KroTek Electronics
4742 Dugas
Pierrefonds, Quebec, Canada
H9J 2B7

   

Name  

_____________________________________________
Address   _____________________________________________
  _____________________________________________
City   _____________________________________________
State/Province   _____________________________________________
Country   _______________________
Postal/ZIP Code   ____________________
Daytime Telephone   _____________________
Email Address   _____________________________________________
   
Model Number   ___Model 1       (Please check one)
___Model 2
___Model 3
___Model 4

Note: For Chrono Lisa model details, please consult our Products page
Quantity   ___  @ US$ 59.00 each = ___________
Shipping and   Handling   ___  @ US$ 15.50 each = ___________
Total                                           ___________
   
Payment Method   Check enclosed
   
Please tell us how   you heard about   KroTek Electronics  
_____________________________________________

_____________________________________________

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