Hantrex Digital Television Set Top Box Order Form

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Name Street/Unit Number Street Name

Suburb Postcode State select ACT NSW NT please note - surcharge of $20 on deliveries QLD SA TAS please note - surcharge of $10 on deliveries VIC WA please note - surcharge of $10 on deliveries New Zealand - we will advise you via email

Delivery Address if different from above:

We deliver by courier, no deliveries to PO Boxes.

Note: You may prefer to have your box delivered to your business address. Please include all particulars.

Phone Fax TTY

Mobile Email address (We need this to confirm your order)

Please select how many J35's you'd like:

Please note - these boxes are demo and refurbished boxes.

1 2 3 Toshiba HDD J35 $1135 delivered

Please select any optional accessories you would like to add to your order.

1 2 3 DVI to HDMI Lead $75

1 2 3 HDMI to HDMI Lead $75

1 2 3 Optical Fibre Audio Cable $15

*Customers please note, if you'd like to pay via cheque/direct deposit, please email or call for our bank details.

Please select your credit card type:

BankCard MasterCard Visa

Please enter the name, as it appears on the card:

Card number:

Expiry date:

/

Verification Number (this is the last three digits printed on the signature panel on the reverse of your card)

If you have any special delivery instructions or comments, please enter them in the box below:

Thank You for your order. We will deliver your order as soon as possible. Please click on 'Submit' below to place your order.

By clicking on Submit - you authorise Hantrex Pty Ltd to debit your card to the value of your order.