Document Retrieval & Reference Report
Order Form
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Please print off this order form and mail it with your payment (check or money order payable to Upper Canada Genealogy) to:

Upper Canada Genealogy, Suite 2807, 33 Isabella Street, Toronto, Ontario, Canada, M4Y 2P7.


CUSTOMER INFORMATION

Name: _____________________________________________
Street Address: ______________________________________
City: __________________________________
Province/State: ______________
Country: _______________
Postal Code/Zip Code: ___________
E-mail address (to confirm receipt of your order): _________________________
Telephone number (with area code): _________________


ORDER DETAILS

Please refer to your index search report for the document number (if ordering a document) or report number (if ordering a reference report)
Document/Report # Price
_______________ _________
_______________ _________
_______________ _________
Sub-total:
_________
Subtract Discount *
_________
Add 5% GST **
_________
Total Amount Enclosed:
_________
* Please enclose coupon
** Canadian residents only (GST # 896548419 RT0001)

Thank you! Your document(s) and/or reference report(s) will be mailed within 10 days of receiving your order.