Payable to: GLEN STRIEMER
RR 1
Simcoe, ON N3Y 4J9
519-582-8485
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HOME HEALTH EDUCATION SERVICE, member of the Better Business Bureau ______________________________________________________________________________

Agreement Dated .............................................


Customer Name:  ............................................................................................ Telephone ......................................


Shipping Address .......................................................................................................................................................                                                                         
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Credit Card information .................................................................. Expiry ...................................... 3 Digit ...............



The TOTAL price for all items (including shipping and tax) is  $____________
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Checks submitted on the LAY-AWAY-PLAN

Jan ______$________   Feb ______$_______ Mar ______$_______  Apr______$_______

May ______$_______    June _____$_______  July ______$_______  Aug ______$_______

Sept ______$_______    Oct ______$_______ Nov _______$_______ Dec ______$_______
               
ITEMS  DELIVERED     TO DELIVER

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Notes:

Customer signature X______________________________

POLICY:  Items purchased on Lay-a-way Plan will be delivered upon completion of payments, however, once a
pattern is established of  cashing cheques the goods may  be delivered earlier in good faith. Under special
circumstances, merchandise previously purchased may be exchanged for other goods of equal value.  Our
agreement is based upon two Biblical principles: Who shall dwell in Thy holy hill? ... (1) He that putteth not out his
money to usuary (interest) (2) "He that sweareth to his own hurt and changeth not" (cancellations) [Ps 15:1,4,5]