JustData
Bodhi History Order Form (BodhiGold Client)
Please complete the blue areas on this Order Form and Mail or Fax it to the Address indicated at the end of this form. To ensure a swift processing of your order, please type details in all relevant sections. ( * = Required Fields)
Name Details
*First Name : *Surname :
Address Details
*Number/Street :
 
*Suburb/City :   *State :
 
*PostCode/Zip : *Country :
Contact No.
*Day Phone : Facsimile :
 
*Email Address :
Where did you hear about this software?

What charting software do
you use?

* When entering Phone/Fax numbers please enter the complete International codes and prefixes.
Product Unit Price
Bodhi History - One Category (on CD-ROM) $ 35.00 AUD
Postage and Handling $11.00 AUD*
TOTAL AMOUNT $ 46.00 AUD
Historical Categories - Select 1 history category from the drop-down box below: ----------------------------------------------
Additional Categories - Select additional categories at $25/each from the drop-down boxes below: -----------------------------
   
   
   
   
Additional categories can be selected (from above) for $25 extra per/category  --- plus added history $
GRAND TOTAL (Total $46 plus added History) ========================================= $
* Australian Postage. International Postage will be charged at cost.
 Paying by Credit Card  If you intend to pay with a Credit Card please complete the section below.
Select Card Type : Card Number :
Name on Credit Card : Expiry Date :
Signature on Card :
 
Total Amount :
$ AUD
Paying By Cheque/Money Order
Please find attached a Cheque for the Grand Total Amount listed in the Product section of this form.
Mailing Details
Please Mail this completed form, with the Attached Cheque/Bank Draft (if applicable) to the following Address:
or Fax: (07) 3821 4190 (Australia)  |  Fax: + 61 7 3821 4190 (International)
JustData - PO Box 1067
Cleveland QLD 4163  AUSTRALIA