Vi-Sal Weather Seal Fax Order Form

Please fill in the form and fax back to us at 09 235 3458. If you have any queries please call on 09 235 3458

Billing Address Details
First Name:  
Last Name:  
Company Name:  
Address/Company Addresss:  
 
City:  
Postal Code:  
Email:  
Phone:  

Shipping Address Details
Address:  
 
City:  
Postal Code:  

Quantity Code Product
Size
Colour
 Price
  4238 Standard 150 metre rolls Black  
  4238 Standard 150 metre rolls White  
  40039 Open in (Limited Stock) 150 metre rolls Black  
    Brociers Pack of 10    
     
Freight
 $
   
Total
 $

Payment Details: (Payment to be made by order OR by arrangement.)
Direct Credit:
Account Name: Visal
Account Number: 06-0241-0101750-00
Bank/Branch: The National Bank Waiuku