Order Form

Asphalt Test Report System Asphalt Test Report System

Date: _________________            

To: From:
McIntyre Associates  
4 - 1140 25th Street  
West Vancouver, BC  
V7V 0A2  
Tel: 604-925-0649  
Fax: 604-925-0659  
Email: info@mcintyreassociates.ca  

1) Select One:    Cheque is Enclosed     Send Invoice (Purchase Order is Attached)

2) Specify Components (separate order required for each physical site):

Description  CA$ US$ Total
Asphalt Test Report System (without PDF/Email) 750 750  
Optional PDF Generation & Email Feature - Add-on 200 200  
Sub Total       
GST (Canadian residents – except NB, NFL, ON, NS) 5%      
PST (Canadian residents of BC) 7%      
HST (Canadian residents of NB, NFL, ON) 13%      
HST (Canadian residents of NS) 15%      
International Bank Transfer (if applicable)   20  
Total Order Indicate currency  CA$  US$      

3) If you elect to pay by International Bank Transfer, please include the US$20 charge in your order. We will send you our bank details along with our invoice.

4) If you send a cheque in US$, then it must be from a US or Canadian bank. We also can accept cheques from many other countries, at the current exchange rate. Please contact us for a quote.

5) Please indicate how you would like your license identified. Use your organization’s name and physical location:

License Holder:        _______________________________________________

Physical Location:    _______________________________________________

6) Specify a contact name and e-mail address for us to send your registration serial number and for system update notices. (We will never use this data for any other purpose, or give it to anyone else.)

Contact:                  _______________________________________________

Email Address:        _______________________________________________