Replacement Parts List
NOTE: If requested color is not available, similar color will be
substituted. Prices are subject to change.
Part Cost Quantity Total Cost
Pad Set ....................$16.99 X _____ = $ ______________
Instructions .................$0.00 X _____ = $ ______________
Merchandise Total: $ _______________
Shipping and handling: $ ________________
Sales Tax: $ _______________
Residents of Quebec, add 5% GST and 9.5% QST.
Residents of New Brunswick, Newfoundland and Labrador, add 13% HST.
Residents of Nova Scotia add 15% HST.
Residents of Saskatchewan add 5% GST and 5% PST.
Residents of Manitoba add 5% GST and 7% PST.
All other Provinces and Territories, add 5% GST.
Grand Total: $ _______________
No shipping and handling on instructions for quantities under 6. Add $.50 for each
instruction over 6, then add applicable shipping and handling
Up to $25.00 .......................$5.95
$25.01 to $50.00 ................$6.95
$50.01 to $75.00 ................$8.95
$75.01 to $100.00 ..............$9.95
$100.01 to $150.00 ............$10.95
$150.01 to $200.00 ............$11.95
$200.01 and up ................. $13.95
Outside Continental USA $10.00
Fill Out For Credit Card
Visa Mastercard
Card Exp. Date: ________________________________
Cardholder’s Name: ____________________________
Card Number: _________________________________
Signature: ____________________________________
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4358-6864 Can Pronto ENG.indd 35-364358-6864 Can Pronto ENG.indd 35-36 1/13/16 2:29 PM1/13/16 2:29 PM
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