Ordering

Phone/fax (03) 6343 2954
International Phone/fax +(61)(3) 6343 2954
Mobile 0419 331 038
E-Mail laracopper@microtech.com.au

To print this form, please right click your mouse and select print.
Fill in your order and fax it to the above fax number, or mail to
Lara Copper, 18 Kerran Crescent, Launceston, Tas, 7250, Australia.

Name -
Address -
City - State -
Zip - Country -
Phone - Fax -

Visa   Card Number  
Mastercard   Expiry Date  
Bankcard   Name on Card  

Ref No Qty Description

AU$
Each

AU$
Total
         
         
         
         
         
         
         
         
         
         
TOTAL  


Mastercard Bankcard Visa
Money Order and Cheque(Allow 10 days for clearance)
All prices are in Australian Dollars.

We do not charge for packaging and handling.
For orders up to $100.00 we charge the actual cost of posting.
Orders over $100.00 please ask for
a quote as we will pay part of the postage charges.