Business
Name |
________________________________________________________________ |
Proprietor's
Name |
________________________________________________________________ |
Address |
________________________________________________________________ |
|
________________________________________________________________ |
City |
________________________________________________________________ |
Province/State |
________________________________________________________________ |
Postal/Zip
Code |
________________________________________________________________ |
|
Telephone:
|
______________ |
Facsimile:
|
______________ |
|
E-mail |
________________________________________________________________ |
|
|
Merchandise |
________________________________________________________________ |
Amps needed |
________________________ (Please
provide your own lighting
and extension cords.) |