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................................................. .............................................................................. 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: --AE--BC--DC--MC--VISA-- From (bank):...........................
Credit Card No: .......................................Expiry Date:........... Name on Card:..................................Signature:..................... Signature not needed if sending directly from your computer. Use security code.* American Express only, please provide 3 or 4 digit security/batch code on card:........ That's the small digits above the last digits of your card number. *The security code is the last 3 digits on the BACK of your credit card. (you may be asked for this as an extra security measure)To Order