Mail or fax purchase order

By mail, fill out the form, enclose your cheque and send it to the following address:

8550 Boul. Pie IX, suite 300
Montreal, Québec
H1Z 4G2

By fax, fill out the form, and send to 514-259-9286 (Faxed purchase order must be charged to a credit card)

Salutation: Mr. Ms.

Name:

First Name:

Address:

City:

Postal Code:

P.O. Box:

Home Phone:

Work Phone:

Extension:

E-mail:

I am a member of Diabetes Québec: yes no

Publications
Tax included

Member
price

Regular
price

Qty.

Total

- Meals for Good Health	24.39 $	26.24 $
- Travel guide for people with diabetes	1- 19 3.00 $	1- 19 3.00 $
- Understanding your Diabetes… and live a healthy life	25.46 $	28.31 $

- Foot Care for Diabetics (12 min.)

25.85 $

28.50 $

Sub-total:
Postal charges: (refer to chart below)
TOTAL:
* Allow 2 to 4 weeks for delivery. The prices can change at any time without prior notice