ABN# 20 858 179 115
PO Box 648
Joondalup DC, WA 6919
Australia
www.valiantco.com
Ph: 61-8-9304 0660
Fax: 61-8-9304 0270
order@valiantco.com
ORDER FORM
# Description Cat.# Qty. Price (AUD) Total
1
2
3
4
5
  Subtotal
THANK YOU FOR PLACING YOUR ORDER! Shipping *
Grand Total
* Leave it blank if you are not sure which one to go with! We will send shipping option along with our Order Confirmation by email.

YOUR DETAIL
First Name Last Name
Billing Address City
State / Prov.
Zip Code
Country Email
Phone Fax
Shipping Address (if different from Billing Address)
If you have previously placed an order with us:
Check to ship to the same address in file!
Check to pay with the same Credit Card on file!

PAYMENT OPTION (in AUD)
MasterCard Visa Western Union Money Transfer
Cheque (Australian Bank only) Australia Post Money Order Wire Transfer

Credit Card Detail
Name on Card Card Number
Expiry Date
Month          Year  
Signature
    Only if you mail the form!


If you decide not to electronically submit the form above, you alternatively may:
- Complete the form and fax it to: 61-8-9304 0270 (International) or 08-9304 0270 (Australia).
- Print it out and snail mail it to: Valiant Trading Co., PO Box 648, Joondalup DC, WA 6919, Australia.


Your order would be confirmed by e-mail within 48 business hours of our receiving it. Thank you for your business!