CUSTOMER ORDER FORM

 

HPC High Performance Coatings Pty. Ltd.,

6 Watson Road, Industrial Park,

Leongatha, Victoria.

Australia, 3953.

A.B.N. 37 074 933 421

 

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Order line:           0356 624719                           Technical Information: 0356 624338

E-Mail Address:  hpcvic@bigpond.net.au                            Fax: 0356 624719

 

CUSTOMER DETAILS                                  DELIVERY DETAILS

NAME:                                                                                   NAME:

 

STREET/No:                                                                          STREET/No:

CITY:                                                                                      CITY:

POST CODE:                                                             POST CODE:

PHONE:                                                                                 PHONE:

 

JOB DESCRIPTION:

 

 

 

ID (inside coating) – yes / no                                              OD (outside coating) – yes / no

Polished Aluminium Finish – yes / no

Colour –

Pistons: Quantity:                  Top Coated Only – yes / no           Top & Skirts Coated – yes / no

 

A.B.N. Number:

 

Preferred method of payment:                      Cheque                                   C.O.D.                                    Cash

Or charge to: (circle card type)                     Mastercard                            Visa                             Bankcard

Credit Card No:                                             Expiry Date:                           Signature:

 

Preferred method                   Your Courier:                                     Account Number:

Of return shipment:               Courier arranged by HPC                

                                                Australia Post

                                                Will Call

 

Please Note:  We need to receive payment before goods are dispatched, unless you are dealing through an authorised HPC Agent, C.O.D. payment via Australia Post, or you are an approved credit applicant.

Thank You.