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Rhinoco Catalogue 2009 - Rhinoco Technology

Rhinoco Catalogue 2009 - Rhinoco Technology

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Fax Order Form<br />

Customer Details:<br />

Company:____________________________________________<br />

Contact: _____________________________________________<br />

ABN No. _____________________________________________<br />

Postal Address: ______________________________________<br />

____________________________________________________<br />

State: ____________________ Post Code: ________________<br />

Phone: _____________________ Fax: ____________________<br />

Mobile: ______________________________________________<br />

Email: _______________________________________________<br />

Delivery Details:<br />

Express Post (Up to 3kg only)<br />

Road Freight (Std Road Freight Charges Apply)<br />

Pick Up - Location:<br />

McGraths Hill<br />

On all pick up items<br />

Haberfi eld sales staff will call to<br />

Villawood confi rm availability<br />

Wollongong & pick up times<br />

Your Nominated Freight Carrier<br />

Company: ___________________________________________<br />

Phone:______________________________________________<br />

Account Code: _______________________________________<br />

Delivery Address: _____________________________________<br />

____________________________________________________<br />

____________________________________________________<br />

State: ____________________ Post Code: ________________<br />

Fax your order to: 02 4577 4885<br />

Order No. __________________<br />

Payment Details:<br />

Account - A/C # _________________________________<br />

Cheque / Money Order<br />

Direct Deposit<br />

Mastercard<br />

Visa<br />

Amex - (Surcharge Applies)<br />

Card No. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _<br />

Exp Date: _ _ / _ _<br />

Card Holders Signature:<br />

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _<br />

(Please Note: Credit card charges may apply)<br />

Special Instructions: ___________________________________<br />

____________________________________________________<br />

____________________________________________________<br />

___________________________________________________________________________________________________<br />

____________________________________________________<br />

____________________________________________________<br />

____________________________________________________<br />

____________________________________________________________________<br />

Part No. Description Qty Unit Price Total<br />

Price<br />

Please Fax to RhinoCo <strong>Technology</strong> on<br />

02 4577 4885<br />

Please photocopy and use this page as often as required to order your products<br />

Total Order Value $<br />

Delivery $<br />

GST $<br />

ORDER TOTAL $

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