Order Form
Name:…………………………………………………………………………………….
Address:….………………………………………………………………………………
…………………………………………………………………………………………….
Telephone number: (H)…………………..………(W)…….…….……………………
E-mail address:……..…………………………………….……….……………………
ALL PRICES INCLUDE VAT AND POSTAGE
Items:
…… X Audiblox Program @ R1300-00 each
R…………
…… X Extra Blocks @ R90-00 each
R…………
TOTAL AMOUNT
R
…………
Method of payment (mark):
Credit card ……………
Cheque..………………
Bank transfer…………
Details for payment by credit card:
Credit card number: ……………………………………………………………………
Expiry date:…………………………CVC number:.………………………
The CVC number is the last three numbers that appear on the signature strip at the back of the card.
You may use the phone, fax or mail to order by credit card.
Details for payment by cheque:
Send a cheque to:
Remedium
PO Box 31186
Totiusdal
0134
Payment by bank transfer:
Phone 083-390-7964 or e-mail info@audiblox2000.com for our banking details. Fax your deposit slip and the completed order form to (012) 332-4259.
Telephone number:
083-390-7964
Fax:
(012) 332-4259
E-Mail:
info@audiblox2000.com