Example OnLine Order Form

FROM :
Name:
Address:
Suburb:		Postcode:
State:		Country:
Phone:		Fax:
Email Address:

---

Item No.	Qty	Description	Price Ea.	Price Total
		Sub Total
		Special Shipping Charges
		Handling Charges
		TOTAL

---

Payment Method :

American Express	Diners
Personal Cheque	Money Order	C.O.D.

Card Number :
Name on card :
Expiration Date :

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