Tasmedals Order Form

Personal Information

First Name:
Last Name:
Email:
Address:
City:
State:
Post/Zip Code:
Country:
Telephone:
Fax:

Product Details All Prices in Australian Dollars.

PRODUCT DESCRIPTION CAT# QTY PRICE EA. TOTAL
$ $
$ $
$ $
$ $
$
$
$
$
$
$
$
$
$
$
$
$
Personalised Engraving
   $8.00per medal
$
    SUBTOTAL: A$ $

Postage

      
Within Australia Only
   Registered Mail $6.80 $
Rest Of The World Shipping
 POA $
    TOTAL: A$ $

PLEASE COMPLETE SERVICE DETAILS
(REQUIRED FOR ALL COMMEMORATIVE MEDAL ORDERS)

SERVICE NUMBER UNIT OR BRANCH RANK LENGTH OF SERVICE

ENGRAVING Details:

EXTRA Comments:

Payment Details:

Pay by Cash / Money Order / Cheque / Credit Card

Please fill in and submit your order, then E-Mail Credit Card details seperately (orders@tasmedals.com.au).
Or - print order form out and with complete details filled in, mail with payment to:

Tasmedals Pty Ltd
8 Orana Place
Taroona
Tasmania, 7053
Australia
CONTACT:
Within Australia -
Phone: 03 6227 8825
Fax: 03 6227 9898

International -
Phone: +61 3 6227 8825
Fax: +61 3 6227 9898

Thank You For Your Order!