Welcome to the down-load-able "simpler" LOCAL OZ Scan of your ordering page.
Simply load this page, remove the html if you wish and print out and scan "as is". |
Email To: firstname.lastname@example.org
This prints as two standard A4 pages - Please scan both pages to us for quick processing of your order, thankyou.
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.
End of Page 1 of 2 - please scan both pages, page one and page two please
Note: Google Chrome does not line up correctly. Firefox and Internet Explorer both work fine
Page 2 of 2 - Please scan and send both pages. If page two is applicable to you.
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 - 2019 Unitech Electronics Pty. Ltd.
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