New Product Order Form

Name *

First Name(s) Last Name

E-mail *

Contact Number *

Prefix Phone Number

Organisation (if any)

Billing Address *

Address

Address Line 2

City State / Province

Postal / Zip Code Country

IMPORTANT DELIVERY INFORMATION: Courier and packaging charges apply to all courier deliveries, but you can arrange your own pick-up from our office in Stoke, Nelson. We cannot deliver Vespex to any rural address in the North Island or any PO Box addresses. If rural North Island, either provide a non-rural shipping address below (e.g. a business that will receive it on your behalf, or a friend/relative in town), or opt to be provided the details of your nearest courier agent.

We do not allow delivery or pick-ups prior to payment being received, unless you have a credit account set-up with us in advance.

Delivery Options *

I will arrange pick-up from Nelson Courier to my shipping address below Send me detail of nearest courier agent

Shipping Address (if different from billing address)

Street Address Line 1

Street Address Line 2

City State / Province

Postal / Zip Code Country

Any additional delivery instructions

Colour	Quantity
Yellow
Natural (translucent)

Colour	Quantity
Yellow
Natural (translucent)

Colour	Quantity
Yellow
Natural (translucent)

Size	Quantity
S
M
L
XL

Size	Quantity
S
M
L
XL