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| Mandatory: Name for registration (up to 40 characters including spaces) | |||||||||||||||||||||||||||||||||||||||
| Product Code | Version No. | No. of Items | Price AUD$ |
| Freight: Freight charges for Powerflex products are listed on a separate page on the company Web site. View the page, choose how you want the product(s) to be shipped, and enter the appropriate freight charge below. | |||
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Important: If upgrading, please supply the serial no. and version no. of your existing product: |
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| Payment: | q Mastercard | q Visa | q American Express |
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Card Number: |
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Expiry: __ / __ |
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| Cardholder's Signature: |
PLEASE FAX COMPLETED FORM to +61 3 9548 9003
OR POST to
Powerflex Corporation Pty Ltd
P.O. Box
624, Mount Waverley, VIC 3149, Australia