Wet Weather Gear / Fittings Order Form

Please Fill in all of the following relevant sections, write clearly and use block letters to allow for fast and accurate delivery. 

Name_______________________________________________________________________________

Address_____________________________________________________________________________

City______________    Post Code_______   State________________

Email_____________________    Phone______________    Fax______________

Product Number Quantity Retail Price (inc. GST)
     
     
     
     
     
*If you need extra room please attach another page.  
Subtotal $
Less 15% $
Freight $
TOTAL $
 Local Freight (in Victoria) up to 10kg  Interstate Freight up to 10kg
 $9.90  $13.20
 >20kg Please contact us for a quote

Credit Card Number ________-________-________-________

Expiry Date _____/_____

I authorize the above charges to be charged to my credit card

Signature_______________________    Date ___/___/___

Fax to (03) 5221 7487