Day of Pink Supply Order Form

Please fill out this form to order Day of Pink Supplies, such as Posters, Stickers, and Buttons.

Shipping of supplies will occur 4 times before the Day of Pink. Please make sure to select which of the following dates you want your supplies shipped on. Please also check deadlines for making orders.

Please also note that there is an additional cost of 8.50$ for tracking and international shipping. The mailing of larger orders may also be subject to additional shipping costs that we wil inform you of prior to finalizing your order.

Payment for your kit can be done online via the Jer's Vision/Day of Pink Canada Helps donation system or by sending a cheque to: Jer's Vision/Day of Pink, 440 Albert St, Suite C304, Albert St Educational Centre, Ottawa, ON K1R 5B5, Canada. Please note if payment is not recieved by the deadlines, your order will not be shipped on the desired date.

Should you have any questions, please email us at: Orders@JersVision.org

Personal Information

Name : *

Address: *

Email: *

Phone number:

School or Organization:

Your Order

Number of Kits: #

Each kits costs 15$ and contains: 6 posters (2 of each); 20 buttons; 30 stickers & includes shipping.

Additional Stickers: #

Each sheet of stickers cost 2$, and includes 30 stickers.

Additional Buttons: #

Additional buttons are 0.50$ each. Buttons can also be ordered in bulk at 40$ for 100. Please note that shipping costs may vary with large orders.

Additional Posters: #

Posters are 2$ each and printed on 11 by 17. Please specify with posters you would like sent to you (See styles on the Resources page).

Shipping date: *

Last week of January (Deadline: January 21, 2012)

Second week of February (Deadline: February 11, 2012)

First week of March (Deadline: March 3, 2012)

Last week of March (Deadline: March 22, 2012)

Please select ONE shipping date, please note the deadline.

Method of payment: *

I plan to pay online

I plan to pay with a cheque