Gordys Flytrap Fitting Order Form

Please complete the following information. Your Name and e-mail are required, thank you.

Name
Address
City
Country
Phone
Email
Payment Method	Credit Card Cheque Other

Quantity	Price per Unit	Total
	$20.00
	Delivery*
	Total

If you are paying by credit card, you will be redirected to a secure page to enter your credit card details.
For your reference, it is recommended that you print a copy of this form before you click on submit.

* For delivery within New Zealand only. Please call, e-mail or fax us for overseas postage costs. If purchasing by Credit Card we will confirm cost before shipping.