ORDER FORM
Part No. Item Names/Description Retail Price Qty. Total
Repair Kits
49 00 405-K Repair Kit 456/457 $29.50
06 10 402-K Hand Piece Repair Kit $12.50
Miscellaneous
49 00 600 Sprayer Cleaner 500ml $12.95
page 7 TOTAL
$
page 8 TOTAL
$
TOTAL
$
SHIPPING CHARGE
$ 7.95
GRAND TOTAL
$
Goodswillbedespatchedbypostwithin2workingdays.
Mail or Fax to: Solo Australia, 24 Healey Road, Dandenong South, VIC 3175
Phone: 1300 798 022 • Fax: 03 9706 9533
Order Online: www.soloaustralia.com.au E-mail: sales@soloaustralia.com.au
Pleasedonotsendcashwiththisorder.MakechequepayabletoClaytonInvestmentsPtyLtd.
Form of Payment:
Credit Card Cheque
Credit Card Number
ExpirationDate
Signature Phone Number
Wecannotprocessyourcreditcardpurchasewithoutasignatureandexpirationdate.
Email:
PLEASE PRINT:
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Address
City State P/Code
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