NDIS Order Form
Easily request an NDIS invoice for your PaperKrane shoes. Simply fill out the form below, and we’ll generate an invoice for you to submit for payment.
Important Information:
PaperKrane is not an NDIS-registered provider, but our shoes may be claimable under Low-Cost Assistive Technology.
This form is for self-managed and plan-managed NDIS participants only.
Orders will be processed and shipped after payment has been received.
If you have already purchased, you can request an NDIS-compliant invoice by forwarding your order confirmation to
contact@paperkrane.com.au
.
1. Personal Details
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
2. Delivery Address
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
3. NDIS Participant Details
NDIS Participant’s Full Name
*
Please include middle names if required
NDIS Participant Number
*
NDIS Participant Date of Birth
*
NDIS Plan Type
*
Self-Managed
Plan Managed
4. Plan Manager Details
Plan Manager’s Name
*
Plan Manager’s Email
*
Plan Managers Phone Number
Please Select Which NDIS Line Item Code is Applicable to this Purchase
*
Low-Cost Assistive Technology for Prosthetics and Orthotics – 03_060000911_0135_1_1
Consumables – 03_090000911_0103_1_1 (Low-cost Assistive Technology for Personal Care and Safety)
5. Order Details
Product Details - please include style name, size and quantity
*
For example: 1 Pair of Pickle Lows Size 36
6. Agreement & Submission
Submit
Should be Empty: