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                      CREDIT CARD ORDER FORM (Rev 1.23)
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1) REMEMBER TO ADD Credit Card banking charge to TOTAL COST for your
order: V/B/M Cards:3%, Amex:5%. Prices are discounted based on C.B.D. 
2) We do NOT accept credit cards for International orders. Instead pay
by Telegraphic Bank Money Transfer or Western Union Money Transfer.
3) Please provide a real PHYSICAL delivery address. Not P.O. Box.
4) This order MUST be PRINTED and FAXED TO 03-96905331 or Scan Emailed
or POSTED back to us WITH THE CARDHOLDER'S SIGNATURE clearly shown.
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ORDER DETAILS OF GOODS OR SERVICES AND ANY SPECIAL INSTRUCTIONS:





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DELIVERY DETAILS:

NAME/ORGANISATION/BUSINESS_____________________________________________

CONTACT PERSON IF BUSINESS_____________________________________________

STREET AND NUMBER (NOT P.O. BOX!)______________________________________

SUBURB_________________________________STATE__________ POSTCODE________

CONTACT PHONE NUMBER (WORK)_________________ (HOME)____________________

CONTACT FAX NUMBER (IF AVAILABLE)(WORK/HOME)____________________

EMAIL ADDRESS (IF AVAILABLE):__________________________________________

CREDIT CARD DETAILS:

CARD TYPE: ___VISA ___MASTERCARD ___AMEX

CARD NUMBER:________ ________ ________ ________ Security Code:________

EXPIRY DATE: (MM/YY) ____/____

CARDHOLDER NAME:______________________________________________________

CARDHOLDER SIGNATURE__________________________

TODAY'S DATE: ____/____/________
               DD / MM /  YYYY
TOTAL AUTHORISED CREDIT CARD DEBIT: $___________________

I hereby authorise Micronica to irrevocably debit my credit card for
the total amount shown.
I agree to the MICRONICA terms and conditions of trade as displayed at
www.micronica.com.au/order. I understand that this order is irrevocable
and non-refundable. I understand I am liable for all charges incurred
in relation to this order and that I will be billed accordingly.
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For enquires contact:
Micronica, 184 Napier Street,South Melbourne,3205,Victoria,AUSTRALIA
Tel: 03-96998844, Fax: 03-96905331, Email: micronica@micronica.com.au
Web: www.micronica.com.au
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