95 Gilbert Street, Latrobe, Tasmania, Australia

Fax: (03) 6426 2606 Mobile: 0417 282 720 After hours: (03) 6428 2720

Fax Back Ordering Form

To use this form please fill in all the details as appears below, including your payment method. If you are paying by credit card please be sure to include all information. Once this form is complete please print it out on your printer, sign it and then fax it to us.

Name and Address - (This address will also be the address to which we ship)

Daytime Phone

Evening Phone

Mobile

Fax number

Items you wish to purchase

Total of the purchase

Plus freight

Total purchase price

Payment method: Cash Cheque Money order Credit card

Credit card details

Card type

Your credit card number

The name appearing on the card

Expiry date as shown on the card

Your signature