PRINTER FRIENDLY ORDER FORM

Print this page, fill in your details and either fax or mail to the following:

Fax Local Area:	9244 9244 8955
Fax Interstate:	08 - 9244 8955
Fax outside Australia:	+618 9244 8955

Mail to: Just Propellers WA Unit 4, 6 Leeway Court Osborne Park WA 6017 AUSTRALIA

YOUR CONTACT INFORMATION
Your Name
Your Organisation
Daytime phone number
E-mail address

PRODUCT INFORMATION
Engine Manufacturer
Model
Year
Horsepower
Solas Part Number

Number of products
Unit Price

Total Price

SHIPPING METHOD

Air Mail Economy Air

BILLING ADDRESS
Name
Street address
City State P/Code
Country

CREDIT CARD DETAILS
Cardholder Name

Card Number

Card Type

Expire: month year

SHIPPING ADDRESS (if different from Billing address)
Name
Street address
City State P/Code
Country

Thanks for using Just Propellers WA