Contact Details
First Name:*
Last Name:*
Company Name:
Payment Details
Amount: (number only)* CDN $
Details: (Quote #, Invoice #, etc.)*
Credit Card Information
Name as it appears on Card:*
Credit Card Type:*
Card Number:*
Expiry Date:* /
Card Security Value:* What is this?
Customer Agreement & Privacy Statement
By checking this box and providing name, email and contact details, you agree to conduct online business with The Surveillance Shop. By submitting this form, you intend to allow The Surveillance Shop to charge payment in the amount specified above to your credit card in accordance with your cardholder agreement. You further agree to allow The Surveillance Shop to collect personal information in accordance with relevant federal and provincial law. This information will be used only for the purpose of processing payment, and will not be disclosed to third parties.
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