Directory of Services Order Form

Directory Order Form
* required field

Contact Information:
Organization
Title	(ie. Ms., Mrs., Mr., Dr., etc.)
First Name*
Last Name*
Address*
City*
Postal Code*
Phone Number*
Email
I would like* note: Please remember the Total to pay online by PayPal.
# of copies   x  $40 =    PST (7%) =   Shipping & Handling = ($7.00 per book)      Total =   Burnaby Community Connections is committed to respecting the privacy of our donors. All information collected is confidential. Credit card numbers are used only for donation or payment processing and are not retained for other purposes.  We will not share, sell, rent, or lease your personal information to other organizations.  Use of donor information will be limited to the internal purposes of Burnaby Community Connections and only to further the purposes of our organization. Click here to see our complete Privacy Policy.