Delirium Order Request

Hello and thanks for shopping at Delirium! (If you reached this page from a search engine, you're probably looking for our main site. Follow the link to go there and browse away!)

Please use the order form below to let us know which item(s) you want, and which sizes and colors strike your fancy. We'll get back to you by the next business day (Tuesday-Saturday) to confirm that your items are in stock, and let you know how much your order will cost to ship.

After we let you know the total of your order, just send us your payment via PayPal (usable by anyone with a credit card) and your order will be on its way ASAP!

We also accept International Money Orders. You can mail your payment to: 23 King St. North, Waterloo, Ontario, Canada N2J 2W6.

Please fill out all fields marked in bold in order for us to process your order as quickly as possible. If you want more than one of any item, or want a particular color, style, and/or size (available colors/styles/sizes are listed beside each item in our catalog pages), please make sure to indicate that as well.


My name:
My email address:

I would like to purchase:

Item Name
Quantity
Color/Style
Size
XS
S
M
L
XL

Mailing address: (Street address or PO Box)
(City, State/Province)
(Zip or Postal code)
(Country)

I will be paying by:

How I heard about the Delirium Website:
(you don't have to tell us, but we would really appreciate it!)

Comments: