Kit Order Form by lindash


Kit Order Form

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									                                                                                                                  KIT ORDER FORM
                                                                                               First Aid Kits, Components and Supplies

                                     Ambulance Victoria First Aid
                       Mail to: Locked Bag 9000, Ballarat Mail Centre, VIC, 3354
                      Fax orders along with credit card details to: (03) 5338 5388

Delivery Information:

Company: ________________________________________________________________

First Name: (Mr/Miss/Mrs/Ms) _________________________________________________
Surname: _________________________________________________________________
Postal Address: ____________________________________________________________
State: _________________________________ Postcode: __________________________

Phone (daytime contact): _____________________ Mobile Phone : _____________________

Ambulance Membership No.: _________________________ Date: ______ / ______ / ______

Payment Methods:

                                               Cheque       Money Order     Cash
                                          Credit Card – Type: VISA/MasterCard/Bankcard

Card Holders Name: ______________________________________ Expiry: _______/____________
Signature: ______________________________________________ Date: ____________________

Qty          Code Description                                                                          Unit Price               GST           Total Cost

                                                                        $10 (inc GST) per order

    Please Note:                                                                                      Total Price
•     First Aid Kit and supply orders will be delivered within 21 days, unless unavailable or when in high demand.
•     First Aid Kits and supplies attract GST, with the exception of certain ‘life saving’ resuscitation products (resuscitation masks, defibrillators
Your Privacy is Important:
•     We collect information for product administrative purposes. For further details on how we securely manage your information and how to
      access this, refer to our Privacy Policy at Or contact us on 03 5338 5200".

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