Order Online | GEELONG OSTOMY

Member's Detail

Surname

Given Name

Address

Suburb

PostCode

This order was placed by:

Print Name

Member of

Distribution Directions:

Month

Year

Delivery Option

Please Note : Postage must be paid before order is shipped (See Cash Sales for Payment)

Please Note Collection is available only after the 4th of the Month ordered on:Monday, Wednesday, Friday 9.30 am to 2.30 pm

Med Cert
(if have one)

Brand

Product Code

Amount

Yes Med Cert
(if have one)

Brand

Product Code

Amount

Yes Med Cert
(if have one)

Brand

Product Code

Amount

Yes Med Cert
(if have one)

Brand

Product Code

Amount

Yes Med Cert
(if have one)

Brand

Product Code

Amount

Yes Med Cert
(if have one)

Brand

Product Code

Amount

Yes Med Cert
(if have one)

Brand

Product Code

Amount

Yes Med Cert
(if have one)

This Order must be submitted BEFORE the 18th of the Month prior to the required month of distribution
( Please note January 13th for February Order)
Please be aware of holidays and place your orders early

Orders

This order form must be submitted BEFORE 2:30pm on the last day we are open BEFORE or on the 20th of the month prior to the required month of distribution (ie. Jan 20th for Feb order). Be aware of holidays and place your orders early.
Late placed orders could incur a fee of up to $30 per each company of product you use to cover suppliers special delivery fees
Orders will be available for pick-up at 6 Lewalan Street, Grovedale, any Monday, Wednesday or Friday’s after the 5th of the month ordered for between the hours of 9:30am to 2:30pm only.

Member's Detail

This order was placed by:

Distribution Directions:

Orders

Special Instructions or Messages