DELIVERY DETAILS

Name *
Address *
City * Postcode *
E-mail
Phone *Fax

* Necessary Information

PRODUCTS ORDERED

19 Litre Bottles		$10.50	Qty
15 Litre Bottles		$9.50	Qty
600ml Bottles (24 per Carton)		$16.00	Qty
1.5Lt Bottles (12 per Carton)		$16.00	Qty
Plastic Cups (per 1000)		$35.20	Qty
Room Temp Ceramic Crock		$33.00	Qty
Water Cooler Rentals		inc GST
Benchtop	12 Months Rental	$99.00	Qty
Room Temp and Cold	12 Months Rental	$99.00	Qty
Hot and Cold	12 Months Rental	$110.00	Qty
Cold Only	12 Months Rental	$99.00	Qty
$99.00 for cooler + your first 2 19ltr bottles FREE		$99.00	Qty

PAYMENT OPTIONS

Cash/Cheque (on delivery) Credit Card
Credit Card Number NoSpaces*

Expiry Date *
Name on Card *

This form is only for enquiries. Once submitted, The Spring Waterman will respond without delay. Thank you for choosing The Spring Waterman.