Please print and fill out this Order Form, mail or fax to address or number below:

Gutter Releaf 106 Arthur Street  Point Edward, Ontario N7V 1V1

Tel: (519) 332-3290, fax: (519) 332-2436

www.guttereleaf.com,  e-mail:releaf@cogeco.ca

Please make checks or Money Orders Payable to Gutter Releaf at above address.  The only Credit Card we accept at this time on this order form is Visa.  For all other Major Credit Cards, including Visa, we accept them through the Online shopping cart store on the product pages.  Thanks.

Customer Information

Name:_______________________________________________________________

Address:______________________________________________________________

City:__________________________________________ 

 State/Prov:_________________________________

Zip/Postal Code:_____________________________________________

Phone:_____________________________________________________________

Visa number & Expiry date:____________________________________________________________________