CUSTOMER and SHIPPING DETAILS

1

Name

................................................................

Address

................................................................

Suburb

................................................................

State

................................................................

Post Code

................................................................

CONTACT DETAILS

2

Daytime Phone

................................................................ *REQUIRED

Fax

................................................................ *Optional

E-mail

................................................................ *Optional

MOTORCYCLE DETAILS

3

Make

................................................................

Model

................................................................
[Please supply as much detail as you can]

Year

 Month ___ ___ / Year ___ ___   [eg 10 / 04]

Unaltered Factory seat ?

 YES / NO  *REQUIRED

SEAT COVER DETAILS

4

Colour

 Black / Black / Black

Part Number

  ___  -  ___  -  ___

POSTAGE CHARGE DETAILS
If you DO NOT have a credit card you should select delivery through Australia Post COD [within Australia only]. If you send Money Order payments in advance you MUST include correct postage amount.

5

Australia Post COD

 YES / NO    Australia Post C.O.D. ............ Fee set by Australia Post
[within Australia only - approx $18 - $22 - ALL money to be paid to Australia Post]

Charges if you pay by credit card.

 Australia Post Express ............ $ 12.00

PAYMENT DETAILS
If you have selected delivery through Australia Post COD [within Australia only] you do not have to fill-in this section.

6

Card Type

VISA / Mastercard / Bankcard *REQUIRED

Card Number

_  _  _  _ - _  _  _  _ - _  _  _  _ - _  _  _  _ *REQUIRED

Card Expiry

Month ___ ___   *REQUIRED
Year ___ ___   *REQUIRED

Name on Card

................................................................ *REQUIRED

SEND YOUR ORDER

7

Agreement

When you Fax/Mail this Order you are agreeing:-
that all information supplied is "true and correct";
that you are the authorised user of the credit card;
that you are authorising a one time only transaction;
that any postage and local tax will also be charged with this transaction;
that you, the purchaser, are liable for any import/customs fees:
that you understand ALL prices and payments are in Australian dollars;
that you understand that manufacture and delivery times are "approximate times";
that you have read this agreement.

FAX to :-

07 3881 3389 [within Australia]

MAIL to :-

SHEEPY HOLLOW
PO Box 5094
Brendale
Qld Australia 4500