BODYSAFE – SAFETY
SOLUTIONS
ORDER
FORM
www.bodysafe@iinet.net.au www.bodysafe.com.au
Print out this form, fill in your details and send with a cheque, money order or your credit card details to the above address:
Name:
……………………………………………………………….
Street:
……………………………………………………………….
Town:
……………………………………………………………….
State:
…………………………….. Postcode: ……………………...
PAYMENT METHOD:
□ Cheque Full
name on card: ………………………………….
□ Money Order Credit card Number: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
□ Credit Card Type of card (eg. Visa): ………………. Expiry Date: …./…..
ORDER DETAILS: Please tick item/s required, below.
Tow Bar Protector. Speed Awareness Indicator. Sleep Assist for Snoring
or Sleep Apnoea.
□ BarGuard □ Speed Saver □ Snooze Control
Costs: $12.00ea $15.00ea $15.00ea
Quantity: ……………………………………………………………………….
Postage: $ 3.00 $1.00 $ 3.00
Any Amount Any Amount Any
Amount
Total Amount: …………………………………………………………………..
(Phone A/H 03 54697235 for trade and fleet prices)