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Order Form


Res No (if applicable):	_______________________________________________________________________
MY ORDER
I wish to order Beamer BM-80		____________________	units
The total cost of my order is		$___________________	incl. GST & delivery
Price of Beamer BM-80 per unit: $450 (incl. GST)
Please add delivery charge per unit for delivery within New Zealand:
Auckland: $3 • Rest of North Island: $5 • South Island: $10
ORDERED BY
Full Name	_______________________________________________________________________
Delivery Address	_______________________________________________________________________
	_______________________________________________________________________
Tel. / Mobile	______________________	Fax. _________________________________________
Email.	_______________________________________________________________________
PAYMENT MODE
Credit Card Payment
Visa	MasterCard
Credit Card no.	__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __
Name on card	______________________________________________________________________
Signature on card	____________________________________________

Expiry date on card	______________________	Date of order _______________________________
Cheque Payment
Please make your cheque payable to NewRoc Limited and remember to include your name,
contact details on the back of your cheque

Please either:
a) Mail your completed order form to:
NewRoc Limited, P.O. Box 65544, Mairangi Bay, Auckland 1311
b) Fax your completed order form to:
(649) 4768230