Page 1 Make check or money order payable to your Gold Canyon

Customer Order Form
Gold Canyon Canada, ULC 5925 Airport Road, Suite 200 Mississauga
Ontario L4V 1W1 Ph: 866-996-4222 Fax: 877-546-4828
Customer Name_ __________________________________________ Date______________________________________________
Street Address/Apt. #_ ________________________________________________________________________________________
City, Prov, Postal Code______________________________________Phone______________________________________________
E-mail______________________________________________________________________________________________________
Host________________________________________________ Party Date___________________Location____________________
Fragrance Consultant Name_ ______________________________ Address______________________________________________
Delivery Date________________________________________________________________________________________________
1.
2.
3.
4.
5.
Item #
Description (Size/Fragrance)
Qty
$ Each
$ Total
Subtotal A
Make check or money order payable to your
Gold Canyon Fragrance Consultant
*
Shipping is based on Subtotal A
**
P ay Sales Tax on either Subtotal A or
Subtotal B for Shipping if applicable in your state
Shipping*
Subtotal B
*** C
hange for Children benefits the Prayer
Child Foundation, a 501(c)(3) organization
and Gold Canyon’s charity of choice.
GST/HST
Provincial Sales
Tax____%**
Subtotal C
Change for Children
Donation***
Customer Signature
Total Due
Fragrance Consultant Signature
Thank you for your order!
PAYMENT METHOD
 a
 Visa
 Money Order
 Cashier’s Check
 Cash
 Check
Check #_________________
cccccccccccccccc
c c c
Card number
Expiration Date V-Code
M
M
Y
Y
(The V-Code can be found at the end
of your credit card number in the
signature section on the back of a Visa
or MasterCard)
Total Amount Charged to Credit Card ________________________________________________________________
Cardholder’s Name__________________________________________________Signature ___________________________________________________________
Address______________________________________________________________________________________________________________________________
City______________________________________________________________State_____________________________________________Zip _______________
Payment is required at time of purchase
Gold Canyon guarantees all candles, accessories and other scented products. Defective products can be returned within 90 days of product shipment from Gold Canyon
for exchange of other products of equal or greater value. All items must be in saleable condition and accompanied with a receipt.
*See reverse for Buyer’s Right to Cancel.
Voyez le verso pour le Droit de Résiliation de L’Acheteur.
*Ask your Consultant for shipping details
Rev 1211 Item# 97209
Would you like to receive updates and discounts via mail or e-mail? Yes ❑ Would you like to donate to Gold Canyon’s charity of choice, the Prayer Child Foundation?
Yes ❑
Would you like to learn more about hosting a Party and earning free products?
Yes ❑
Do you know of an organization that would like to sell less and earn more with Gold Canyon’s Fundraising Program? Yes ❑
Would you like to learn more about becoming a Gold Canyon Fragrance Consultant?
Yes ❑ Buyer’s right to cancel
You may cancel this contract from the day you enter into the contract until 10
days after you receive a copy of the contract. You do not need a reason to cancel.
If you do not receive the goods or services within 30 days of the date stated in the contract, you may cancel
this contract within one year of the contract date. You lose that right if you accept delivery after the 30 days.
There are other grounds for extended cancellation. For more information, you may contact your provincial/
territorial consumer affairs office.
If you cancel this contract, the seller has 15 days to refund your money and any trade-in, or the cash value of
the trade-in. You must then return the goods.
To cancel, you must give notice of cancellation at the address in this contract. You must give notice of
cancellation by a method that will allow you to prove that you gave notice, including registered mail, fax, or
by personal delivery.
DROIT DE RÉSILIATION DE L’ACHETEUR
Vous pouvez résilier le présent contrat à compter de la date de conclusion du
contrat, et ce, pendant une période de 10 jours après la réception d’une copie du
contrat. Vous n’avez pas besoin de donner une raison pour résilier le contrat.
Si vous ne recevez pas le bien ou le service au cours des 30 jours qui suivent la date indiquée dans le contrat,
vous avez un an, à compter de la date du contrat, pour résilier le contrat. Toutefois, vous perdez ce droit de
résiliation si vous acceptez la livraison après la période de 30 jours. Le droit de résiliation peut être prolongé
pour d’autres raisons. Pour de plus amples renseignements, communiquez avec votre bureau provincial de la
consommation.
Si vous résiliez le présent contrat, le vendeur doit, dans les 15 jours qui suivent, vous rembourser toute somme
que vous lui avez versée et vous remettre tout bien qu’il a pris en échange ou la somme correspondant à la
valeur de ce dernier. Vous devez alors retourner le bien acheté.
Pour résilier le présent contrat, il vous suffit de donner un avis de résiliation à l’adresse mentionnée dans ce
contrat. L’avis doit être donné par un moyen qui vous permet de prouver que l’avis a réellement été donné, y
compris par courrier recommandé, télécopieur ou remise en personne.
I HEREBY CANCEL THIS TRANSACTION.
_________________________ _____________________________________________________
(Date)
(Customer’s Signature)
Address For Notice:
Gold Canyon Canada, ULC
5925 Airport Road, Suite 200
Mississauga Ontario L4V 1W1
Ph: 866-996-4222
Fax: 877-546-4828
Manitoba residents send notice to:
Gold Canyon Canada, ULC
c/o Monk Goodwin LLP
800 Centra Gas Bldg.
444 St. Mary Avenue
Winnipeg, Manitoba
R3C 3T8
Fax: (204) 957-0423
Nova Scotia residents send notice to:
Gold Canyon Canada, ULC
1959 Upper Water St
Suite 1700
Halifax, NS B3J 3N2