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Name.........................................(Company)........................ Address........................................Town/City...................... State..........................................ZIP/POST Code.................. Country........................................E-Mail:........................ Phone...........................Mobile........................Date............ Delivery Address and Phone No................................................. .............................................................................. Briefly, where did you hear about Procon Technology?..........................
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ADD GST (10% of total) ONLY if delivery address in Australia.......$.......... ADD POSTAGE and HANDLING charges as detailed in pricelist..........$.......... ADD INSURANCE charges (optional) as detailed in pricelist..........$.......... TOTAL..............................................................$..........
Type of card: --MC--VISA-- From (bank):...........................
Credit Card No: .......................................Expiry Date:........... Name on Card:..................................Signature:..................... Please provide 3 digit security code on card:........ *The security code is the last 3 digits on the BACK of your credit card. *For PAYPAL click on the logo on our webpage.To Order