Local Purchase Completed By e-Transfer

This form collects all the information required on my end and provides you the necessary information to complete the purchase and get the goods in your hands once built.

e-Transfers are to be sent to: info@dkwremotes.ca This is a automatic account tied to 2215434 AB Ltd. No password is needed. With the information below, I will email a receipt before beginning of next business day.

Name

First Name

Last Name

Address

Phone

(###)

###

####

Describe machine remote is to be on

pickup or mail

Local Pickup to Edmonton

To be mailed

What color fo you want the hand remote faceplate

Company name for receipt

The Wizard of RodOctober 28, 2022