----------------------------------------------------------------------- BANK DEPOSIT, T/T or CHEQUE PREPAID PAYMENT ORDER FORM (Rev 1.07) ----------------------------------------------------------------------- - Notes: 1) This form is to be used for orders which are prepaid by Bank Deposit, Telegraphic Transfer or Cheque only. For Credit Card orders please Use the Credit Card Order form instead. 2) Contact us by Phone or Email for our Bank Deposit Details. We don't like to put them on the internet ;-) 3) Add $38.50 Inc GST in ADDITION to the normal delivery fee if you want goods to be POSTED to a P.O. Box. To cover our manual labour cost. Normally shipping is by Courier directly to your door. 4) For Personal and Company Cheque payments allow one week to clear. 5) This order form should be EMAILED or POSTED back to us with the signature of the responsible person clearly shown. ---------------------------------------------------------------------- ORDER DETAILS OF GOODS OR SERVICES AND ANY SPECIAL INSTRUCTIONS: ---------------------------------------------------------------------- DELIVERY ADDRESS AND DETAILS: NAME/ORGANISATION/BUSINESS_____________________________________________ CONTACT PERSON IF BUSINESS_____________________________________________ STREET AND NUMBER______________________________________________________ SUBURB_________________________________________________________________ STATE__________ POSTCODE________ CONTACT PHONE NUMBER (WORK)_________________ (HOME)____________________ CONTACT FAX NUMBER (IF AVAILABLE)(WORK/HOME)____________________ EMAIL ADDRESS (IF AVAILABLE):__________________________________________ NAME OF PERSON ORDERING:_______________________________________________ SIGNATURE OF PERSON ORDERING:__________________________ TODAY'S DATE: ____/____/________ DD / MM / YYYY AMOUNT OF ORDER (DON'T FORGET DELIVERY AND GST): $___________________ I hereby order Micronica to provide the ordered goods or services. I agree to accept responsibility for loss in transit at our own risk. I agree to the MICRONICA terms and conditions of trade as displayed at www.micronica.com.au/order I understand that this order is irrevocable and non-refundable and that I am liable for all charges incurred in relation to this order, including any legal costs if I refuse to accept and proceed with this order and that I am liable accordingly. ---------------------------------------------------------------------- For enquires contact: Micronica Tel: 03-96998844 Email: micronica@micronica.com.au, Web: www.micronica.com.au 184 Napier Street, South Melbourne, 3205, Victoria, AUSTRALIA ----------------------------------------------------------------------