Custom Payments

This form is for custom payments. If you have landed on this page, you have been directed by our office to make a payment of a set amount. If not, please return to the homepage here.

Contact Information
Name*
First OR Institution Last OR Department
Email*
Billing Address*
Address Line 1 Address Line 2 City ZIP / Postal Code

Must match address on credit card used for payment
Shipping Address (if different from billing address)
Address Line 1 Address Line 2 City ZIP / Postal Code
State / Province / Region*
Country*
Custom Payment
Payment Amount (CAD)
Note: Prices are displayed in Canadian currency (CAD). Total amount is already calculated to account for exchange rates on US/International orders.
Price:
Shipping/Exchange (CAD)
Price:
GST (CAD)
For Canadian orders only.
Price:
Payment Description*
Please click the checkbox below to confirm the purchase as described. Once you click "Submit," you will be directed to a payment page where you can enter your credit card information.
- Confirm payment for total payment amount.
Optional Comments
Total
$0.00

Custom Payments

Contact Information

Custom Payment

Search Options.