JB Hi Fi - NDIS Order Request

JB Hi Fi - NDIS Order Request
NDIS PARTICIPANT DETAILS
Participant Name

First NameLast Name
Participant Email
example@example.com
Participant Phone Number

Area CodePhone Number
Participant Address

Street Address

Street Address Line 2

SuburbState / Territory

Post Code
PLAN MANAGER / OT DETAILS
Is this order being funded via NDIS, or a NILS provider?
NOTE: This form should only be used for orders being funded via NDIS.

Any quote requests or order submissions relating to NILS programs should be submitted by the Loan Provider on your behalf.

Please contact your Loan Provider and instruct them to contact JB Hi Fi Business directly.
Plan Manager / OT Name

First NameLast Name
Plan Manager / OT Email
example@example.com
Plan Manager / OT Phone Number

Area CodePhone Number
ABOUT YOUR ORDER
Please list the items that you wish to order (add rows for each additional product). NOTE: Products that are listed online as JB Marketplace items cannot be purchased through this form, and are only available via the JB Hi Fi retail website directly.
How would you like to receive your order?
Preferred pickup location:
Collection from a local store will be subject to stock availability. Where stock is not available at your nominated store, our team will contact you to discuss alternative locations and/or delivery options.
Who will be collecting your order?
Alternate Pickup Contact Name

First NameLast Name
Alternate Pickup Contact Email
example@example.com
Alternate Pickup Contact Phone
Please enter a valid phone number.Format: (000) 000-0000.
Do you approve delivery in the event that stock is not available at your preferred pickup location?
Delivery Address:
Alternate Delivery Address

Street Address

Street Address Line 2

SuburbState / Territory

Post Code
Next Steps

Once you have submitted this form, one of our Customer Care Team will issue a pro forma invoice for the requested products to both the Applicant and Plan Manager/OT email addresses listed on your submission. We will endeavour to provide this invoice within 72 hours.

The pro forma invoice contains JB Hi-Fi’s terms and conditions of sale.

Please note invoices are valid for 28 days from the date of submission. If payment is not received before this date then the order may be cancelled and a new submission required.
Privacy Policy
By completing this form, you agree that your personal information will be handled in accordance with our Privacy Policy.
Do you agree to our Privacy Policy?
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JB Hi Fi - NDIS Order Request

NDIS PARTICIPANT DETAILS

PLAN MANAGER / OT DETAILS

ABOUT YOUR ORDER

Privacy Policy