Please print out this page, fill in details, then phone or fax us.

Your details

Name	*
Address	*
Delivery Address	*
Contact phone number	*
Fax number	*
Email	*
Message	*

Your Order

Item code	Product name		Price	Quantity	Amount
(example) 430-TB-0003	(example) Tetsubin Tea Pot Shintama Arare		(example)110.00	(example)1	(example)110.00
*	*		*	*	*
*	*		*	*	*
*	*		*	*	*
*	*		*	*	*
*	*		*	*	*
*	*		*	*	*
				Subtotal	*
				Delivery Charge	*
				Express Charge	*
				COD Charge	*
				Total	*

** Delivery charge
Brisbane/Gold Coast - $5.50 per delivery. Waived if product order is worth $100.00 or more.�@
Other Queensland - $11.00 per delivery. Waived if product order is worth $200.00 or more.
New South Wales - $11.00 per delivery. Waived if product order is worth $200.00 or more.
Victoria - $11.00 per delivery. Waived if product order is worth $200.00 or more.
Australian Capital Territory- $11.00 per delivery. Waived if product order is worth $200.00 or more.
Northern Territory- $16.50 per delivery. Waived if product order is worth $200.00 or more.
South Australia- $16.50 per delivery. Waived if product order is worth $200.00 or more.
Western Australia- $16.50 per delivery. Waived if product order is worth $200.00 or more.
Tasmania- $16.50 per delivery. Waived if product order is worth $200.00 or more.
**Express charge
Extra $20.00 per delivery.
**GST
All product prices, delivery charge, and express charge are GST inclusive. You do not need to add GST on them.
**Cash on Delivery charge
Extra $8.80 per delivery.

Payment Method (Please tick one)

( ) Bank Account Deposit Please deposit the fund to the account below. Bank: Westpac Banking Corporation Branch: Bundall branch, QLD BSB: 034660 A/C no.: 195398 A/c Name: Yoshida Shouten Pty Ltd *We will despatch goods after confirming your deposit.

( ) Cash on Delivery by Australia Post Please pay to Australia Post when you receive goods. *Please add extra COD charge of $8.80. *We will despatch goods straight away.

( ) Credit Card (Please tick one) ( ) VISA ( ) Mastercard ( ) Bankcard Card Number ____ ____ ____ ____ CVN(last 3 numbers on signature panel) _____ Valid Date __ / __ Name on card _________________ Signature _________________ *We will process your payment, then despatch goods.

We will confirm your order within 2 business days�@of your fax by phone, fax or Email. If you do not receive our response in 2 days, please contact us.

Yoshida Shouten Pty Ltd
ABN 99 105 515 259
Box 9243, Gold Coast MC, QLD 9726 Australia
Phone 0414 550 991 Fax 07-5532-3514