Take advantage of the huge benefits of shopping by credit card, safe, convenient and reliable. We accept Visa Card,
Mastercard, Diners Card or AMEX. Please note: Minimum credit card purchases are AUD$ 20.00 excluding Tax and 
excluding freight. Simply write or type in your details on each line that are relevant for us to  process your order. 
All details must be fully completed .     Failure to complete the form correctly will ultimately delay your order.

YOUR TITLE (Mr/Mrs/Ms/Dr.etc.): __________ YOUR Full Name : __________________________________________

YOUR Company Name (if applicable) : _______________________________________________________________

YOUR Full Street Address : ________________________________________________________________________

YOUR Suburb or Town : ____________________________ YOUR City : _____________________________________ 

YOUR State : __________________ YOUR Post Code : __________________________

YOUR Email Address : ___________________________________ Note: We do not deliver to Post Office Boxes.

YOUR Phone Area code : ________  YOUR LAND LINE Phone Number : _________________________________

YOUR Phone Area code : ______  YOUR MOBILE CELL PHONE Number : _________________________________
_______________________________________________________________________________________________
Please select your preferred method of payment: ( select one method of payment only )
Visa Card:[__]     MasterCard: [__]       Diners Card: [__]     AMEX: [__]    Electronic Funds Transfer (EFT) :[__] 
_______________________________________________________________________________________________
Credit or Debit Card details: example: 4 x 4 digit format eg: 1234 5678 9101 8642  (Diners & Amex have less digits)

CARD HOLDER's FULL NAME: __WE WILL CALL YOU TO CONFIRM_DO NOT PUT__________

Your 16 digit Credit Card Number: _WE WILL CALL YOU _Credit Card Expiry Date: _DO NOT PUT_

The Three Digit Security Code: DO NOT PUT   (This can be found on the rear of your credit/debit card )
_______________________________________________________________________________________________
Your full details must be completed. Failure to do this will delay the order. Please note, a "Post Office Box" is 
not a recognised residential or cardholder address by Credit Card Facilitators or the Banking Industry in general 
and is not acceptable as a delivery address. Please complete the appropriate ordering section below :-

Order No. (if applicable): O/No: ____________________________________
          Description of goods            Part Number            Quantity                      Ex Tax Price In AUD$ 

Item 01.________________    ____________________    ____________

Item 02.________________    ____________________    ____________

                                                                    Sub Total...............AUD$ __________ : ________ c

                                                                    Add freight.............AUD$ __________ : ________ c
                                     Australian  GST is 10%                                                                  
                                                               Add Australian GST......AUD$ __________ : ________ c

                                                           Total in Australian Dollars AUD$ __________ : ________ c
 
If you require further items, please add to this FORM (page 1 only) and please simply print another form.   
Please avail yourself with the concept of direct deposit or EFT (Electronic Funds Transfer) direct to our 
business account and of course remember to advise us that you have effected an online EFT 
transfer and what the order is and where it is to be delivered to. Once confirmed, your order will be 
processed.     Trading terms resolution: as of May 16th 2005.

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Local deliveries, Prices are based on application depending on your location. As a rule, we ship via economical 
Australia Post.  Insurance is always an option.  We do however, suggest that all Valuable goods be fully insured as 
there are some areas where items do go missing due to goods being left and not signed for. 
Do you require insurance , Yes / No ? : select one. 
LOCAL SHIPPING via Australia Post : Allow  2 ~ 5 working days Shipping via various couriers
click on Australia Post deliveries for an accurate  Australia Post quotation - Click here

_________________________________________________________________________________________________

This section (below) need only be completed if the card holder's particulars are different from you, the person
perhaps a relative ordering (above). ALL card holder Details must be completed in full  prior to ordering:
------------------------------------------------------------------------------------------------
Please select your preferred method of payment: (select one only)
   Visa Card:[__]  MasterCard: [__]  Diners Card: [__]  Amex: [__]  Electronic FundsTransfer (EFT) :[__]
_________________________________________________________________________________________________
Credit card details:  An example: 4 x 4 digit format eg:  1234  5678  9101  8642

CARD HOLDER's FULL NAME**: _WE WILL CALL YOU TO CONFIRM_DO NOT PUT__________

Your 16 digit Credit Card Number** :_WE WILL CALL YOU TO CONFIRM_DO NOT PUT__________

Credit Card Expiry Date:  _DO NOT PUT_

The special three digit security number on the rear of your credit or debit card: _DO NOT PUT_
_________________________________________________________________________________________________

This section (below) need only be completed if the card holder's particulars are different from you, the person ordering
the above item(s).   The person perhaps is a near relative ordering the above. ALL card holder details must be fully 
completed prior to sending:   For simplicity, the letters CH will be used in lieu of the 2 words "Card Holder's".

CH Title (Mr/Mrs/Ms/Dr.etc.): ______ CH Full Name: _____________________________________________

CH Full Street Address : ________________________________________________________________________

CH Suburb or Town : ____________________________ CH City: _____________________________ 

CH State : _____________________ CH Post Code : ____________________

CH Email Address : _______________________________________________________________

CH Phone Area code : ______ CH Phone Number : _____________________________

CH Mobile Number : ______   ___________    ____________  eg: 04 1234 5678

For those people wishing to pay by Visa, MasterCard, or Diners Card, AMEX , we will confirm your order by phone or 
email so please ensure you have entered those relevant details correctly to securely verify you are you and 
not someone else.

Contact telephone Number : __________________________ Best contact Time: _________________________

Please share your constructive thoughts about us or about our web site. Your positive feedback comments are
always welcome and are considered very important and valuable to us. 
Are there any special delivery procedures that you wish to share  with us to effect your deliver correctly to you ?
________________________________________________________________________________________________

 Need to check our sales Terms and conditions ? - click here Copyright © 1998 - 2018 Unitech Electronics Pty. Ltd.  

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