| NAME | DATE |
| Billing Address | Delivery Address (if different from Billing address) |
| Contact Phone | Fax Phone |
| E mail Address | |
| SeaCalm Number/s | Shipping Charge (Select One) |
| Regular Airfreight (10–21 days) $12.00 | |
| Courier (3 - 6 days) $25.00 | |
| CREDIT CARD # | CARD TYPE (Circle One) |
| Mastercard | |
| EXPIRY DATE | Visa |
| Month Year | American Express |
| Diners Club | |
| SIGNATURE | |
|
If you prefer, send us two faxes, one with your card number, the second
with your card expiry date. SeaCalm Industries 1 Mountjoy Place Onehunga Auckland 1006 New Zealand |
We
will respond immediately to any correspondence from you. Telephone: (Intl) +649 438 2860 Fax: (Intl) +649 438 2861 |