Order Form

ORDER FORM

Print this form out on your printer, fill it in, and post it or fax it.

PLEASE NOTE: Make all payments payable to Upton Distributors

Credit Cards Also Accepted via Fax Order - Mail Order - Phone Order

Product Code	Item Description (size and colour where applicable)	Price	Quantity	Item Total















Total Cost of Order :
Postage and Handling:
Total including GST :				_________
Note: Where applicable state sizes and colours

SHIP TO:

Name: ___________________________________________________

Address: __________________________________________________________________

City/Town: ______________________________________

State (Prov) : ____________________________________ Post Code:____________

Country: ______________________________________ Phone:___________________

Email Address: ___________________________________ (Put notes on back of page - if required)

PAYMENT METHOD - In Australian Dollars made payable to Upton Distributors
Credit Card Type :	Visa	Mastercard	Bankcard	Cheque	Money Order
Credit Card Number :	__ __ __ __	__ __ __ __	__ __ __ __	__ __ __ __	FORM: LD02
Name On Card : _______________________			Expiry Date : ______________
Cardholder's Signature : ___________________________

POST ORDER TO:
UPTON DISTRIBUTORS
P.O.Box 6402,
G.C.M.C,
Queensland 4217
Australia

Phone Order : +61 755740047

Fax Order: +61 755740047

Email: sales@lingeriedomain.com