Ships Of The Great Lakes Screensaver Retail
Countertop Display and Bulk quantities order form.
(If this form doesn't automatically print, please print it by selecting File, then Print on your browser.)


Store/Retail name_____________________________________________

Contact name____________________________________________

Shipping Address_________________________________________


25 ct Countertop displays ______x  $99.75 = __________

25 ct Refill (no display box)_____x  $96.00 = __________

100 ct bulk (no display box)_____x $375.00= __________

                                                        Total= __________

U. S. funds payable to "Great Lakes Digital Imaging"
Mail to:
Great Lakes Digital Imaging
P.O. Box 45
Carleton Michigan

Personal check payments may not be shipped until check clears.
Canadian orders must be paid with an international money order.
No Canadian personal checks. Only U.S. and Canadian orders only.