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  sales@unitechelectronics.com |
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sales@unitechelectronics.com |
    This prints as two standard A4 pages - Please Fax 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 (USD $14.50 approx )
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 Provence (if applicable) : ___________________________
YOUR Country : ___________________________________ YOUR Postal or Zip Code : __________________________
YOUR Email Address : _______________________________________ Note: We do not deliver to Post Office Boxes.
YOUR Country code :_______ YOUR Phone Area code : ______ YOUR Phone Number : ________________________
YOUR Country code :_______ YOUR Phone Area code : ______ YOUR Fax 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: _______________________________________________________________________
Your 16 digit Credit Card Number: ______ ______ ______ ______ Credit Card Expiry Date: ____ / ____ (eg: 09/19)
The Three Digit Security Code: ____ ____ ____ (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
Exported items NO GST ( No Tax ) is added.
Add freight.............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 Fax both pages, page one and page two please
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