Magellan Explorer Order Form
Australia - Aquarian Technologies
PO Box 820, Castlemaine, VIC, 3450
Sales: 1800-240-774, Fax: (03) 5475-1888
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Please use this form when ordering by fax or mail:
Name _____________________________________________
Company _____________________________________________
Address _____________________________________________
_____________________________________________
City/Town _____________________________________________
Country _______________________ Post Code _________
Telephone ________________________________
EMail ________________________________
[ ] Cheque [ ] AMEX [ ] Money Order
[ ] BankCard [ ] VISA [ ] MasterCard
Name on Card _______________________________________
(Only if different from Name above)
Credit Card Number: ___________________________________
Expiration Date: _____ /_____
Signature: _______________________
EMail Address: _______________________
___ Copies of Magellan Explorer on CD @ $AUD 77.00 = $_______
___ Copies of Magellan Explorer email @ $AUD 66.00 = $_______
Where did you hear about Magellan Explorer?
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Please make cheques payable to: Aquarian Technologies.