----------------------------------------------------------------------- BANK DEPOSIT, T/T, CHEQUE OR POSTAL ORDER PAYMENT ORDER FORM (Rev 1.01) ----------------------------------------------------------------------- - Notes: 1) This form is to be used for orders which are prepaid by Bank Deposit, Telegraphic Transfer, Advance Cheque or Postal Order Cheque only. 2) Contact us by Phone or Email for our Bank Deposit Details. We don't like to put them on the internet ;-) 3) This order MUST be FAXED TO 03-96905331 or POSTED or EMAILED back to us WITH THE SIGNATURE OF RESPONSIBLE PERSON clearly shown. DELIVERY ADDRESS AND DETAILS: NAME/ORGANISATION/BUSINESS_____________________________________________ CONTACT PERSON IF BUSINESS_____________________________________________ STREET AND NUMBER______________________________________________________ SUBURB_________________________________________________________________ STATE__________ POSTCODE________ CONTACT PHONE NUMBER (WORK)_________________ (HOME)____________________ CONTACT FAX NUMBER (IF AVAILABLE)(WORK/HOME)____________________ EMAIL ADDRESS (IF AVAILABLE):__________________________________________ NAME OF PERSON ORDERING:_______________________________________________ SIGNATURE OF PERSON ORDERING:__________________________ TODAY'S DATE: ____/____/________ DD / MM / YYYY AMOUNT OF ORDER (DON'T FORGET DELIVERY AND GST): $___________________ I hereby order Waverider Communications to provide the ordered goods or services. I agree to accept responsibility for loss in transit at our own risk. I agree to the Waverider Communications terms and conditions of trade as displayed at www.waverider.com.au/order. I understand that this order is irrevocable and that I am liable for all charges incurred in relation to this order. Including any legal costs if I refuse to accept and proceed with this order and that I am liable accordingly. ---------------------------------------------------------------------- ORDER DETAILS OF GOODS OR SERVICES: ---------------------------------------------------------------------- For enquires contact: Waverider Communications Tel: 03-96998844, Fax: 03-96905331, Email: waverider@micronica.com.au Web: www.waverider.com.au 184 Napier Street, South Melbourne, 3205, Victoria, AUSTRALIA