Order Form

ORDER FORM

5407 State Route 15A
P.O. Box 68
Hemlock, New York 14466
(585) 367-3040
info@hemlockcanoe.com

Order Form

Billing Information

Shipping Information

* Indicates required field

Name *

First

Last

Address *

City *

State *

Zip Code *

Phone Number *

Email *

Date: *

Special Instructions *

Ship Via *

Fright Quote* *

Hull Construction *

Kevlar®/Hybrid hull Premium+ hull Premium Lite

Quantity *

Description *

Price *

Total *

Quantity *

Description *

Price *

Total *

Quantity *

Description *

Price *

Total *

Quantity *

Description *

Price *

Total *

Quantity *

Description *

Price *

Total *

Quantity *

Description *

Price *

Total *

Quantity *

Description *

Price *

Total *

Payment

Visa MasterCard Discover Amex
Card Number: CALL THIS IN, DO NOT E-Mail OR PUT ON THIS FORM !!
Expiration Date: CALL THIS IN, DO NOT E-Mail OR PUT ON THIS FORM !!
CCV : CALL THIS IN, DO NOT E-Mail OR PUT ON THIS FORM !!

Subtotal
Freight
Charges*
NYS Tax**
Total
Deposit
Balance Due

*Please contact us with delivery ZIP code for Freight Quote.
**NYS tax only for orders picked up or delivered/shipped to NY State addresses.
    Contact us by phone or e-mail with any questions ?
    Order Form may be printed and forwarded to us by mail or e-mail.
    We will confirm by return mail or e-mail.

Order