Order Form

Please provide the following contact information:

Name
Title
Organization
Work Phone
FAX
E-mail
URL

Please provide the following ordering information:

Product overview

QTY	DESCRIPTION	PRICE in ZAR
	Subtotal
	VAT at 14%
	Total

 

	BILLING
Purchase Order #
Account Name

 

PAYMENT METHOD

Cash on receiptCheque on receiptBank transfer in advanceElectronic paymentMy company has terms

 

	SHIPPING & PAYMENT METHOD Please note that customers out of Johannesburg are requested to make payment in advance and arrange own courier. We deliver only to our registered dealers in most parts of Johannesburg and Pretoria. Delivery is free for orders above R2000; otherwise there is a charge of R50 excluding VAT. Payment: cash or confirmed Internet transfer. Cheque payments must be approved by management in advance. Please read our Cheque Policy and Conditions of Sale.
Will collect
Please deliver
Street Address
Address (cont.)
Area
City
Postal Code
Country

Please enter your notes or special instructions here:

Information Request Form

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