Chilli Dance Wear Order Form

Please fill out the order form below and press the Submit button. If you are concerned about online security, your details can be given to us by telephone, fax or mail.

IMPORTANT NOTE : Method of Payment - EFTPOS facilities are available at the shop. We also accept money orders and payment by Mastercard, Visa or Bankcard. We do not recommend sending credit card details by email. Credit card details should be provided by telephone, fax or mail. Cheques are accepted by prior arrangement.

Sizes: SML, MED, LGE.
Prices are Retail, and are in Australian (AUD) $ only.
GST is included.
Postage & Handling is not included in pricing.
Wholesale enquiries are welcome!

Enter the order date of: (dd/mm/yy)

Please provide the following contact information:

Name

Title

Organization

Work Phone

Home Phone

FAX

E-mail

URL

You are ordering our product range of:

Please provide the following ordering information:

CODE/PRICE QTY SIZE COLOUR

Please Note: Postage & Handling to be added to order!

BILLING:

Purchase Order # For wholesale purchases only!

Account Name

SHIP TO: OTHER COMMENTS:

Street Address

Address (cont.)

City

State

Postal Code

Country