HIRE ORDER FORM

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PLATINUM FITNESS

PLATINUM FITNESS EQUIPMENT HIRE ORDER FORM

* indicates required fields

*FIRST NAME:

*SURNAME:

*STREET ADDRESS:

*SUBURB:

*POSTCODE:

*HOME/WORK PHONE:

*MOBILE PHONE:

*EQUIPMENT FOR HIRE:

*DELIVERY AREA:

SYDNEY METRO ADD $55
LOWER BLUE MOUNTAINS ADD $90
WOLLONGONG ADD $90
LOWER CENTRAL COAST ADD $90
SHELLHARBOUR ADD $90
UPPER CENTRAL COAST ADD $110
SOUTHERN HIGHLANDS ADD $110
OTHER

*HIRE PERIOD:

1 MONTH
3 MONTHS
6 MONTHS
12 MONTHS
OTHER

*METHOD OF PAYMENT:

CASH ON DELIVERY
CREDIT CARD
EFTPOS ON DELIVERY
OTHER

*DATE REQUIRED (GUIDE ONLY):

*PREFFERED DELIVERY DAY (GUIDE ONLY):

*DELIVERY TIME ( WE WILL CONTACT TO CONFIRM):

*REFERAL SOURCE:

*EMAIL ADDRESS:

*PREFFERED CONTACT:

HOME/WORK PHONE
MOBILE PHONE
EMAIL

EXTRA INFORMATION:

PLEASE SEE SPECIALS PAGE FOR CLEARANCE STOCK
sales@platinumfitness.com.au or Ph: 02 9759 5788

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