ORDER FORM

TO: Procon Technology P.O. Box 655 Mt.Waverley 3149 Australia. (Same address for 20+ years).
ABN: 94479362616. Phone: +61-3-98306288. Email: procontechnology@tpg.com.au
Manager: Peter King. For customer comments and questions - Click here

PLEASE PRINT IN BLOCK LETTERS.

Name.........................................(Company)........................

Address........................................Town/City......................

State..........................................ZIP/POST Code..................

Country........................................E-Mail:........................

Phone...........................Fax:..........................Date............

Delivery Address and Phone No.................................................

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Briefly, where did you hear about Procon Technology?..........................

PRICES SUBJECT TO CHANGE WITHOUT NOTICE

For Prices and Part Numbers, please see www.procontechnology.com.au
PLEASE SUPPLY (include part no, description and price)...
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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: --AE--MC--VISA-- From (bank):...........................
Credit Card No: .......................................Expiry Date:...........


Name on Card:..................................Signature:.....................

Please provide 3 or 4 digit security/batch code on card:........

*The security code is the last 3 digits on the BACK of your credit card. Or for AMEX the 
small digits above the last digits of your card number on the front.

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