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 $1,000 $14.85 inc GST $14.85 inc GST Quote
Order value over $1,000 $14.85 inc GST $18.90 inc GST Quote
       

Credit Card Number_______,______,______,______.__

Expiry Date_____________________CSV_____________

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

Signature___________________________ Date________

Please fax to  03-52231150   for immediate attention

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