Member Name Address Telephone Number
Appliances Required & Quantities
Please enter the number required.
Micropore_Tape 1" @ $ 2.00 Leukoflex_Tape 1" @ $ 4.50 Leukoplast_Tape 1" @ $ 5.50 Leukoplast_Tape 1" Waterproof @ $ 6.50 Transpore_Tape 1" @ $ 3.00 Curved_Scissors @ $ 9.00 Transpore_Tape 2 " @ $ 6.00 Micropore Tape 2" @ $ 4.00 Hostoma (odour neutralizer) @ $ 5.00
Freight Has Been Pre Paid Select Yes No Freight Contribution Select Vic $8.00 Interstate $10.00
Total $
