ORDER FORM

Fax: 07 5596 7633

Int'l: +61 7 5596 7633

Email: info@keldapark.com.au

ABN: 72 519 371 452

 

*Name:

 

*Delivery Address:

 

*Suburb:

 

*State:

 

*Postal Code:

 

*Country:

 

*Telephone:

 

*Email:

 
* Information required for delivery and to enable me to contact you if needed
Products Requested
Code Description Colour/Size Qty Unit Price Extended Price
           
           
           
           
           

Australia Post charges apply to all orders.*

*Minimum freight charge = $6.30.

 

I will contact you with final price incl. postage if requested.

 Sub-Total  
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TOTAL $

Method of Payment (please tick one):

Australia Post Money Order

Mastercard

Personal Cheque (funds to clear prior to shipping)

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Bankcard

      Cheques should be make payable to D Taylor t/as Keldapark

 
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I, ________________________________,  authorise Keldapark to charge my card for the

                (please print your name)

 total of this order.
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(order cannot be processed without signature)
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CARD NUMBER:

 

EXPIRY DATE:

 

 Three Digit Security Code:

 

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