Possio PM 80 Order Form

Order Form For Possio PM 80 GSM Fax Machine

All fields must be filled out before order can be processed

Your Details (All fields must be completed)

First Name

Last Name

Your EMail Address

Delivery Address

Delivery Address

City

Postal/ZIP Code

Country

Daytime Telephone number
(include country code)

Mobile Phone Number

Fax Number

Credit Card Details (All fields must be completed)

Credit Card Number

Special 3-digit Security Code at back of card

Card Expiry Date

Type of card (VISA/Mastercard)

Issuing Bank

Number of Possio PM 80 GSM Fax Machines required (at US$1095 each)

Shipping and Insurance Costs:
Express Shipping/Insurance costs for Europe: US$85
Express Shipping/Insurance costs for North America: US$85
Express Shipping/Insurance costs for South America: US$95
Express Shipping/Insurance costs for Russian Federation: US$120
Express Shipping/Insurance costs for Asia: US$110
Express Shipping/Insurance costs for Australasia: US$95
Express Shipping/Insurance costs for Middle East: US$100

Note:
This form is for export orders ouside the South African Common Monetary Area.
For local South African pricing, call +27-(0)21-418-2418

Do you have any special instructions (delivery, customs, invoicing etc)?

First Name
Last Name
Your EMail Address
Delivery Address
Delivery Address
City
Postal/ZIP Code
Country
Daytime Telephone number (include country code)
Mobile Phone Number
Fax Number

Credit Card Number
Special 3-digit Security Code at back of card

Card Expiry Date
Type of card (VISA/Mastercard)
Issuing Bank