Printable Order Form

For Australian Customers

To order, please print this form from your web browser and fill in the following details.

Please send ____ copies of the following items :

___________________________________________________________________________________

at a cost of: $_____________________

Payment & Delivery

Payment in Australian currency may be by cheque, postal order or credit card (cheques may require several days clearance). Make cheques or postal orders payable to Esoteric Technologies Pty Ltd. Postage and packing is included in the price for any location in Australia. Please add $45 for express air delivery to other countries. Please send cheques or money orders for amounts under $35.

Name and Address

Name: _____________________

No. & Street: _____________________

Suburb: _____________________

City/State:______

Postcode:______

Phone (Day):_____________

Computer System Information

Type: 386/486/Pentium/Macintosh/Unix/Other
CD Rom: Yes/No

Payments to: Esoteric Technologies Pty Ltd, PO Box 159 Stepney South Australia 5069, Australia.

Please charge this purchase to my credit card:

° Visa ° Mastercard ° Bankcard

Card Number: |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|

Expiry Date: |___|___| / |___|___|

Amount: $_____________________

Name on Card: __________________________________________

Cardholder Signature:

Either fax to: +61 8 8362 6108
or post to: ESOTERIC TECHNOLOGIES P/L
PO Box 159 Stepney SA 5069 AUSTRALIA

You can also email us at admin@esotech.com.au