ORDER FORM Ergo the SEAT

To order, please complete the form below and print. Mail or fax to:
Ergo - The Seat Pty. Ltd. P.O. Box 542, Camden NSW Australia 2570 Phone/Fax (02) 4655 6565

Customer Details
First name:
Last name:
Postal/delivery Address:
City/Town:
State:
Postcode:
Email:
Phone:
Mobile:
  An email will be sent to you confirming receipt of your order
Referred by:
 Or, how did you hear about this product e.g. Internet
Delivery time:
Please allow up to 28 days for delivery. However, delivery is generally within a week of payment being cleared.
ORDER DETAILS
MODEL STYLE DESCRIPTION PRICE (GST incl)
QTY
 TOTAL $A
01000-9 ULTIMATE Gel seat w-Lycra cover $109 each
$
     
ORDER TOTAL: 
 $
Postage and Handling: Included in the above price for orders within Australia, Thank you
Please note: The Seat® will not fit most exercise bikes, unless they have a conventional bicycle rail mount.
BILLING INFORMATION
Credit Card type: 
Visa MasterCard
 
Credit Card number: 
Expiration date: 
 e.g. 06/13
Name on Credit Card: 
Signature: 
Please note: This is not a secure server, so please do not email your credit card details.
PRINT
Ergo - The Seat Pty. Ltd. P.O. Box 542, Camden NSW Australia 2570
Phone/Fax (02) 4655 6565 www.ergotheseat.com.au Email: info@ergotheseat.com.au