Shipment Order for Dried Marihuana - Marihuana Seeds

Date : December 2010

• To:
  Health Canada
  Accounts Receivable
  Ottawa ON K1A 0K9
  P/L 3203B
  Fax.: 1-613-957-3495
  E-mail: ar-cr@hc-sc.gc.ca
• From:
  Name:
  Customer Number:
  Telephone:
• Description:
  Dried Marihuana for medical purposes (minimum of 5 grams)
  Marihuana seeds for medical purposes
• Quantity:
• Price:
  $5.00 /per gram
  $20.00/30 seeds
  Subtotal:
  Tax:
  Total:
• Total:
• Required information if paying by credit card:
  Date:
  Name of card holder:
  Amex #:
  Master Card #:
  Visa #:
  Expiry date:
  I authorize Health Canada to charge $  to my credit card.
  Signature of card holder:
  Telephone:

Payable to the Receiver General for Canada in Canadian funds by certified cheque, money order, Visa, Amex or Master Card.

*** See reverse of shipment order form for Provincial Tax Rates ***

Tax Table by Province

Quantity of dried marihuana for medical purposes (in grams)	Cost: $5.00 per gram $	Provinces of Alberta, Manitoba, Prince Edward Island, Quebec, Saskatchewan, Yukon Territories(GST of 5%) $	Provinces of Newfoundland and Labrador, New Brunswick, Ontario(HST of 13%) $	Province of British Columbia(HST of 12%) $	Province of Nova Scotia (HST of 15%) $
5	25.00	26.25	28.25	28.00	28.75
10	50.00	52.50	56.50	56.00	57.50
15	75.00	78.75	84.75	84.00	86.25
20	100.00	105.00	113.00	112.00	115.00
25	125.00	131.25	141.25	140.00	143.75
30	150.00	157.50	169.50	168.00	172.50
35	175.00	183.75	197.75	196.00	201.25
40	200.00	210.00	226.00	224.00	230.00
45	225.00	236.25	254.25	252.00	258.75
50	250.00	262.50	282.50	280.0	287.50
55	275.00	288.75	310.75	308.00	316.25
60	300.00	315.00	339.00	336.00	345.00
65	325.00	341.25	367.25	364.00	373.75
70	350.00	367.50	395.50	392.00	402.50
75	375.00	393.75	423.75	420.00	431.25
80	400.00	420.00	452.00	448.00	460.00
85	425.00	446.25	480.25	476.00	488.75
90	450.00	472.50	508.50	504.00	517.50
95	475.00	498.75	536.75	532.00	546.25
100	500.00	525.00	565.00	560.00	575.00
105	525.00	551.25	593.25	588.25	603.75
110	550.00	577.50	621.50	616.00	632.50
115	575.00	603.75	649.75	644.00	661.25
120	600.00	630.00	678.00	672.00	690.00
125	625.00	656.25	706.25	700.00	718.75
130	650.00	682.50	734.50	728.00	747.50
135	675.00	708.75	762.75	756.00	776.25
140	700.00	735.00	791.00	784.00	805.00
145	725.00	761.25	819.25	812.00	833.75
150	750.00	787.50	847.50	840.00	862.50
Quantity of bag(s) of marihuana seeds for medical purposes	Cost: $20.00 per bag $	Provinces of Alberta, Manitoba, Prince Edward Island, Quebec, Saskatchewan, Yukon Territories (GST of 5%) $	Provinces of Newfoundland and Labrador, New Brunswick, Ontario (HST of 13%) $	Province of British Columbia (HST of 12%) $	Province of Nova Scotia (HST of 15%) $
1	20.00	21.00	22.60	22.40	23.00
2	40.00	42.00	45.20	44.80	46.00
3	60.00	63.00	67.80	67.20	69.00