ShareExpress
(Retail v4.0)
Order via fax/post
First name:
_______________________________________________________
Print
Last Name:
_______________________________________________________
Print
Email Address:
____________________________________________________
Please write clearly
Delivery address:
__________________________________________________
Zip
code: ____________ State: ___________
Country: ___________________
Phone
Number:____ - ____________ Mobile:
__________________________
Please select method of
payment
[ ]
Pay by Credit
Card [ ] Visa [
] MasterCard [
] Amex [sorry, other cards
unavailable]
Card Number
: 
Expiry
date : 
Amount
to be paid : AU$124.99 (price
includes $25.00 for postage & handling Australia wide)
Name on
card: ____________________________________
[please
print]
Signature:
________________________________________ [thank you]
[ ] Pay by Cheque or money order
Make cheque/money
order payable to Click2.com Pty Ltd
Total amount to be
paid: AU$124.99 (price
includes $25.00 for postage & handling Australia wide)
-------------------------------------------------------------------------------------------------------------------
Our
fax number
61- 3 - 95285781 (if dialing outside Australia) 03 - 95285781 (within Australia)
Our mailing
address
Click2.com Pty
Ltd 16 larch St. Caulfield, 3162 VIC Australia.
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