ORDER FORM


Date : __________________

   How to Order :
  1. Print out this order form and fill in quantity, model and the unit price.
  2. Fax to us or email for our order confirmation subject to items available.
  3. Order confirmation or Out of stock notification will be sent to you.
  4. Upon receipt of our order confirmation that valid for 3 days, make your payment in advance to out bank account.
  5. Fax or email to us again the previous order form with our Order Number filled in and stick copy of your transfer Confirmation.
  6. Order will be despatched immediately upon receipt of Payment.
    Cara memesan barang :
  1. Cetak Order Form ini dan isi banyaknya, model dan harge satuannya.
  2. Fax atau email kepada kami untuk mendapat konfirmasi order bila barang masih tersedia.
  3. Akan kami kirim konfirmasi order atau pemberitahuan tentang habisnya stock. Order konfirmasi berlaku 3 hari.
  4. Setelah menerima order konfirmasi segera kirimkan uang ke Rekening bank kami dalam 3 hari.
  5. Fax kembali Order Form yang pertama dikirim kepada kami dengan mengisi nomor order konfirmasi dan copy/bukti kiriman uang yang ditempel di bawah order form.
  6. Order akan dikirim segera setelah diterimanya kiriman uang.

Order by & Shipping Address    Pemesan & Alamat Kirim
Name : _________________________________
Address : _______________________________
                _______________________________
                _______________________________
City : _______________ Zip : _______________
Country : _______________________________
Tel. : (            )                 Fax : (            )
Email : _________________________________
 If Shipping Address is different :
Name : ___________________________________
Address : _________________________________
                _________________________________
                _________________________________
City : __________________ Zip : ______________
Country : _________________________________
Tel. : (            )                   Fax : (            )
Email : ___________________________________

Item Number Model Number Quantity Unit Price Rp.
       
       
       
       
       

Note :
1. Shipping charges will be informed when confirming your order.

Ordered By :





________________________________
Name
Send in your order to :

Fax : (061) 4530845        

E-mail : sales@aquafiltron.com