Fax to Hilltribe

Please complete this form and Fax to 1-902-429.5141 or call our Halifax Office at 1-902-492.8254. For further information about payment please click HERE.

Qty

Code

Description

Color

Size

Cost

Can$

Total

Tax

Shipping

Grand Total

Billing Information

Payment Information

First Name

Visa

MasterCard

Amex

Last Name

Card Holder Name

Address

City

Credit Card Number

Code/Zip

Prov/State

Expiration Date

Country

Month

Year

Phone

All Billing and Payment information will be destroyed after completion of purchase transaction.

Fax

PLEASE NOTE: If a ticked check box does not appear next to your appropriate Credit Card after printing, please circle the card you use before faxing this form.