
| SECOND MEMBERSHIP INFORMATIONS | |
|---|---|
| Second card: | I want a 2nd membership card ** Required if the second card is checked |
| ** Type of subscription: |
New member Renewal; Membership # : |
| ** Package: |
LIFETIME membership : 125$ + taxes = 141.09$ 2 years membership (same residence) : 30$ + taxes = 33.86$ 2 years membership (other residence) : 60$ + taxes = 67.73$ |
| ** First name: | |
| ** Last name: | |
| ** Address: | |
| ** City: | |
| ** Postal Code: | |
| ** Date of birth (dd/mm/yy): | |
| ** Home phone: | |
| Office phone: | |
| Cell. phone : | |
| Email: | |
| Would you like to have gift certificates of Point Zero 8 applicable on the transportation ? |
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| Do you want to add gift certificates ? Yes No |
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| x 8.00$ N.B. Each gift certificate is a value of 8.00$, no expiry date. |
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| Do you want to add disposables breathalysers ? | |
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Yes
No
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Disposables breathalysers are offered to you at the price of 4.00$+tx.
For more details see this page.
** Required if you select 'Yes'. |
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| ** Number of breathalyser(s) ? : |
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Freight and handling (1 to 4 free) From 5 to 15 Breathalyzers : 8.00$ (Canada Post) From 16 or more Breathalyzers : 20.00$ (Purolator with signature) If you come to our office 0$ 6921 Jarry East, St-Leonard, Quebec, H1P 1W7, from Monday to Friday between 11hAM to 9hPM |
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| USE THIS FIELD TO LEAVE A MESSAGE TO POINT ZERO 8 | |
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| METHODS OF PAYMENT | |
| Paypal / Credit card (Immediate Subscription, secure site) | |
| Check / Money Order (Mail Subscription) |
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