ORDER FORM




First Name
   
Surname

Address:
Delivery address for courier  
Not a PO Box please.



Street

Suburb

City     
   Post code
Country
e-mail: *

Please ensure you provide your e-mail address
Phone number  Day           Phone number  Night  
Cellphone               



Select Item
Qty
Select Colour

Enter Amount



= $




= $




= $




= $



= $

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Enter Total
  $



Please print form and send with your cheque or money order to:

KOTUKU AOTEAROA
PO Box 3062
Waikuku Beach, 7448. North Canterbury,
New Zealand (Aotearoa)
ph/fax 64 03 310 0278 mobile 027 303 9599

or e-mail: kotuku@nzswingseat.com for direct credit details.
Please tag your direct credit payment as follows: Particulars: (S/Seat) Code: (Your Name) Reference: (Your phone number as appears on your order.)