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Fax order form- Wet
Weather Gear
Name_____________________________________
Address____________________________________
City_______________________________________
Post
Code__________________________________
Contact details- Please print
Phone________________________
Email_______________________
Fax________________________
Item
ordered_________________________________
Colour_____________________________________
Size________________________________________
Quantity____________________________________
Amount $____________________________________
Add Freight from table
below_____________________
| Freight Costs |
Local -in Victoria |
Interstate |
International |
| Order value to $1000 |
9.90 inc GST |
13.20 inc GST |
Quote |
| Order value over $1000 |
9.90 inc GST |
16.00 inc GST |
Quote |
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Credit Card
Number_______,______,______,______.__
Expiry
Date__________________________________
I authorize the charges above
inc freight to be charged to my credit card
Signature___________________________
Date________
Please fax to 03-52217487 for
immediate attention
Shopping cart software
and credit card processing provided by ezimerchant
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