HaidaBucks Order Form

Print this page and fill out the form below. We included multiple lines for T-shirts for those ordering more than one size. When complete, mail or fax using the contact information below. And thank you for your support of HaidaBucks!

T-shirt Quantity_______ Size S M L XL @ $25Cdn each = __________ Color__________

T-shirt Quantity_______ Size S M L XL @ $25Cdn each = __________ Color__________

T-shirt Quantity_______ Size S M L XL @ $25Cdn each = __________ Color__________

T-shirt Quantity_______ Size S M L XL @ $25Cdn each = __________ Color__________

Ceramic Coffee Mug Quantity_______________ @ $15Cdn each = __________

Stainless Travel Mug Quantity____________ @ $23.50Cdn each = __________

Subtotal of my order____________________________

NOTE: Shipping and Handling will be added to your order. All orders shipped via REGULAR MAIL ONLY! All taxes and duties are the responsibility of the buyer.

Credit Card Information:

Name on Card _____________________________________________

Billing Address for Card______________________________________

Credit Card Number_________________________________________

Expiration Date_______________

Shipping Information:

Name_____________________________________________________

Address___________________________________________________

City, State or Province_______________________________________

Country & Postal Code_______________________________________

Phone Number (in case we have questions)______________________

Fax Orders to: 1-250-626-5530

Or Mail to:

HaidaBucks Café
Legal Defense Fund
Box 769 1675 Main Street
Masset, Haida Gwaii, BC
Canada V0T1M0

Credit Card users may also call us at 1-250-626-5548 to place orders.