PLEASE FAX THIS ORDER FORM to (61) 2 9620 9111

Pendrum International Pty Ltd  A.B.N 47 077 086 947  T/As  UNIQUE AUTOSPORTS   Unit 1,  No 20 Tucks Rd Seven Hills, N.S.W 2147 AUSTRALIA 
Ph:    + 61 2 9620 9000
Fax:   + 61 2 9620 9111
www.uniqueautosports.com.au      sales@uniqueautosports.com.au							

Date____/____/_____                 Full Name: ___________________________________

Address____________________________________________

Suburb_________________        State ___________Country  _____________________

Post Code / Zip Code ____________     E-mail _________________________________

Phone No___________________ Mobile______________________

Please Send To Me The Following {make_____________ model____________________ year__________]

Qty (___) Description Of Goods_________________________________________A$_______-___

Qty (___) Description Of Goods_________________________________________A$_______-___

Qty (___) Description Of Goods_________________________________________A$_______-___

Qty (___) Description Of Goods_________________________________________A$_______-___

Check out our freight section on our home page for freight and packing charges.

TOTAL FREIGHT  AUD$_____-___         TOTAL PRICE: AUD$_________-____
Please Tick box ? if you require a quote in $AUD for the freight charges before debiting your card. 

##### Please charge this total to my credit card.

Bankcard/Visa /Mastercard (please circle your card)

Card No__________-_________-_________-__________       Expiry Date ____/____

Last 3 Digits on back of card _ _ _ (For Security Reasons)

Cardholder’s Name__________________________
Signature Of  Cardholder___________________________________

##### OR DIRECT DEPOSIT #####
Unique Autosports Pty Ltd 
Commonwealth Bank of Australia
Castle Towers Shopping Centre
Castle Hill
BSB: 062 139
A/C: 1009 6098

PLEASE DELIVER TO (if different from the above address):

ATT: ____________________________________________________

Address______________________________________________________

Suburb_________________________       State __________Country_______________

Postcode/Zip Code____________

I have read and understand and accept Unique Auto Sports terms of trade, conditions of 
dispatch and disclaimer.   
												signed_______________date __/___/___