Fill out and send off this form to inquire about or order PASKOE products. Your Full Name: Your Address: Town/Suburb:           State:     P/Code: Country: Area Code:  Phone Number: E-Mail Address: Shipping Address: (if different than above) As AboveDetails Below Name: Address: Town/Suburb:           State:     P/Code: Country: Qty.         Package Ordered   5kg PASKOE = $7   10kg PASKOE = $17   40kg PASKOE = $28   TONNE PASKOE = $275 Currency in Australian Dollars Inquiry / Comment Box (limited to 600 characters)

* * IMPORTANT * * ONCE THIS FORM HAS BEEN SENT A SALES PERSON WILL CONTACT YOU TO CONFIRM YOUR ORDER Freight charges will vary depending on destination. Once you know the final amount of your order you can pay using any of the options below. Payment Options: You can pay by Cheque or Money Order Send Payment To: PASKOE 1545 Tennyson Road Kamarooka, Victoria, 3570 or Pay online using your credit card here