Please circle which $5/$10 sale
packs you are wanting (each
Payment sale pack is $120/$240
Options: GST included)
Return Via Fax to
Credit Card: VISA/ MASTERCARD/ AMEX 07 5528 6728
Name: _____________________________________________________________
Credit Card No: _____________________________________________________
Exp: _________________ Amount to Pay $ _____________________________
$15 express post
Signature: _________________________________________________________ (Australia wide)
Bank Transfer: (leave pharmacy name as reference) Cheque Payment:
The Cosmetic Department Please make all cheques payable to:
Commonwealth Bank The Cosmetic Department
BSB: 064430 PO Box 1438
Account: 10726457 Southport BC QLD 4215
Delivery address: ___________________________________________ Contact name: ___________________________
____________________________________________________________ Contact number: _________________________
____________________________________________________________
____________________________________________________________
Email address: ______________________________________________________
PLEASE CONTACT US ON 07 5532 6220 IF YOU REQUIRE A TAX INVOICE BEFORE PAYMENT CAN BE MADE – OTHERWISE YOUR TAX
INVOICE WILL BE ENCLOSED WITH YOUR ORDER.
THANK YOU FOR YOUR SUPPORT &
BUSINESS
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