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Place Your Order Using This Form

Now there's an alternative way for you to order! Just fill out and submit the form below. If you need to order by phone please feel free to call 416-361-2205. Once you place your order Access-r-ease will contact you with a summary of your order, including the total amount in Canadian dollars. You can make your payment by check, money order, or sending money through PayPal, even if you don't have a PayPal account.

Your order will be shipped to you once your payment is received. Checks and money orders should be made payable to:
Access-r-ease at 69 Yonge Street, P.O. Box 17035, Toronto, Ontario, Canada, M5E 1Y2.

If you want to pay by credit card or with your PayPal account, you'll be e-mailed an invoice by PayPal, with a secure link that lets you make your payment even if you don't have a PayPal account.

Name: *
E-mail Address: *
Phone Number: *
Shipping Address (Line 1): *
Shipping Address (Line 2):
City/Town: *
Province/State: *
ZIP/Postal Code: *
Country: *
Other information concerning delivery of your order (e.g. entry code if you live in an apartment):

Product 1 Name (also enter desired color, size or other option if available): *

SKU #:
Quantity: *
Product 2 Name (also enter desired color, size or other option if available):

SKU #:
Quantity:
Product 3 Name (also enter desired color, size or other option if available):

SKU #:
Quantity:
Product 4 Name (also enter desired color, size or other option if available):

SKU #:
Quantity:
Product 5 Name (also enter desired color, size or other option if available):

SKU #:
Quantity:
Please enter promotional code if you have a coupon:
How do you want to pay for your order? *
Check or money order (you will be e-mailed instructions) Credit card or PayPal account (You do not need a PayPal account. PayPal will e-mail you instructions and a secure payment link.)
How did you hear about Access-r-ease? *



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