Example Fax or Post Order Form

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Please print this form to either fax or post your order.

FROM :

Name : .............................................................................................
Address : .........................................................................................
Suburb : ..................................................... Postcode : ...................
State : ..................................................... Country : .........................
Phone : ....................................... Fax : ..........................................

TO :

Greg Wapling
PO Box 5317 Mordialloc VIC 3195
Mobile: 0434 821 307

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

Payment Method :
[ ] Visa	[ ] Mastercard	[ ] Bankcard
[ ] American Express	[ ] Diners
[ ] Personal Cheque	[ ] Money Order	[ ] C.O.D.

[ ][ ][ ][ ] [ ][ ][ ][ ] [ ][ ][ ][ ] [ ][ ][ ][ ]
Name on card : ...........................................................................
Expiration Date : ............... / ............... / ...................................

Signature : ..................................................................................