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Order Form - Australia
Please MAIL, PHONE, FAX or EMAIL your order to:
Masters Medical Pty Ltd - Suite 505, Level 5,Westfield Office Towers, Parramatta NSW 2150
Ph: (02) 9689 3655 Fax: (02) 9689 2866
Date:  | _ _ _ _ /_ _ _ _ /_ _ _ _ |
Name: | _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ __ _ _ | 
Street: | _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _  _ _ __ _ _ _ __ _  |
City:   | _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ | Phone: | _ _ _ _ _ _ _ _ _ _ _ _  _ _ _ _ _ |
State:  | _ _ _ _ _ _ _ _ _ _ _ _ | Fax:   | _ _ _ _ _ _ _ _ _ _ _ _ _ _ _  _ _ | 
Postcode: | _ _ _ _ _ _ _ _ _ _ _ _ | Email:  | _ _ _ _ _ _ _  _ __ _ _ _ _ _ _ _ |
Description (Click on links for detail) Unit Price QTY  Total 
TENS Machines    
Spectrum II TENS Machine
285.00
    
Comtens TENS Machine
165.00
    
Epix-XL TENS Machine
495.00
    
Spectrum Max-SD TENS Machine 
495.00
    
Accessories    
Recharger Kit, two batteries and recharger 
70.00
    
Electrodes - Pals-Flex, 5cm x 5cm, 4/pkt 18.00    
Other Items    
     
     
Courier - Australia Wide  5.50   5.50
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TOTAL
Payment Details :
Credit Card  Cheque
Credit Card Particulars: Visa  M'card  Bank Card 
Name on Card: 

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Expiry Date: | __| __| / | __| __|
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