Order Form
We welcome any comments or enquiries that you may have:

Name:
Phone:
Email:
Comment/Enquiry:

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Membership Number:
Mr Miss Mrs    Other   
Initials:
Surname:
Address:
Suburb/Town:
Postcode:
Telephone Number:
Mobile Number:
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Brand Name, Item or Description
Code Number
Quantity
Note: To obtain more than the monthly allowance, a signed Extra Supply Form must be produced
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Personal collection of orders is Monday to Thursday between 9-30am & 2-00pm

Postage & Packaging Fees From January 2009:

Melbourne Suburbs $6.00
Victorian Country $8.00
All Interstate Parcels $10.00

DOUBLE ORDERS >>> Please include DOUBLE THE POSTAGE FEE

Please make cheques and money orders payable to ILEOSTOMY ASSOCIATION (VIC) Inc.

TELEPHONE ORDERS WILL BE ACCEPTED, BEFORE 10AM PREFERABLY.
Phone orders will be posted if postage is in credit. Always allow time for the items to be ordered and despatched - this can be up to 14 days.

ILEOSTOMY ASSOCIATION (VIC) INC. | A15792X | ABN 83 887 357 989
Postal Address: PO Box 32 Flinders Lane VIC 8009
Suite 322 3rd Floor Block Arcade 98 Elizabeth St Melbourne VIC 3000
Tel (03) 9650 9040 | Fax (03) 9650 1723
 
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