Industry Canada
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Assistive Technology Links (AT-Links)


Level 2 - Systems

Order Form Example

To assist you in organizing your order forms to include multiple formats, refer to this example.

This suggested text should also be part of your Web site ordering system. Notice that the form includes a telephone number, TTY number (for people who are deaf or hard of hearing) and an e-mail address so that clients can communicate directly with your department if they have specific needs beyond those outlined in the form or if they have any difficulty in using the form.

Multiple Formats

(Name of department) makes all publications available in multiple formats in compliance with the Government of Canada Communications Policy. Multiple formats provide access to a publication for people unable to access the original product.

E-Text: The fastest and easiest method for us to provide a publication for people unable to access the original product is to forward an electronic text file. This file can easily be read by people who are blind or have low vision using a screen reading device that will interpret the text into audio, braille or large print. The text file can also be used by people who are deaf or hard of hearing unable to access our videos and audiotapes. They are also beneficial to people with physical disabilities unable to manipulate printed products. E-text files explain all visuals and non-text items in text so that none of the information in the original product is missing.

If you use a computer and are able to access text files, we recommend choosing the e-text option for fastest delivery.

Choose a Multiple Format

__ Audiocassette
__ Braille Grade One
__ Braille Grade Two
__ Large Print
__ Described Video (for videos only)
__ Captioned Video (for videos only)
__ E-Text

Delivery Options

E-Text:

__ Please send me the e-text file on a CD at the address provided. (Include an area on the form where the client can insert their address and e-mail address. On the Web site, link the options here to the appropriate fields).

__ Please e-mail me the text file at the e-mail address provided.
My e-mail address: _____________________________________________________.

Printed or physical media:

__ Please send the material to address provided. (Include an area on the form where the client can insert their address and e-mail address. On the Web site, link the options here to the appropriate fields).

Contact us by Telephone or E-Mail

If you have any requirements not covered in this form or if you have any difficulty in using the form, please contact us in any one of the following ways:

Toll-Free Order Number:
TTY Order Number:
E-Mail Order Desk:

We will respond to your enquiry in a timely manner.

Next Module: Communications Planning

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