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Print this form and fax to Fuelsaver International cc Fax: +27(0)31 564-0834
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FUELSAVER - ORDER DETAILS
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MARK 7:
MARK 8:
MARK 10:
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Quantity: _______ @ R 350.00 (Each)
Quantity: _______ @ R 400.00 (Set of 4)
Quantity: _______ @ R 120.00 (Each)
TOTAL
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R _______
R _______
R _______
_______
R _______
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PAYMENT OPTIONS
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Credit Card q; Cheque q; Electronic Transfer q
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| NB GOODS WILL BE DESPATCHED BY FASTMAIL AFTER PROOF OF PAYMENT |
CREDIT CARD PAYMENT:
Master Card q; Diners Club q; Visa q; Amex q |
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Cardholders Name: ____________________________
Cardholder's ID: _______________________________
Credit Card No: ________________________________
Expiry Date : _________________________________
CVC No: __________
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FUELSAVER INTERNATIONAL cc
Tel: + 27(0)31 569-3318 | Fax: +27 86 600 2244 | Email: stromberg@mweb.co.za
Address: Office 2 Greystone Park Heliport; 135 Old North Coast Road; Glen Anil; Durban; South Africa
Postal Address: P.O. Box 20053; Durban North; 4016; South Africa
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