Order Form: Tax Invoice
Survey Design and Analysis Services Pty Ltd - ABN 37 051 831 826
Contact:Karl and Helen Keesman, PO Box 1206, Blackburn North VIC 3130 - Phone: 03 9878 7373
Fax:03 9878 2345 sales@survey-design.com.au Web: http://survey-design.com.au
If this Order Form does not print properly, click here for a PDF version of the Order Form.
Item
Total $A including GST
   
   
   
POSTAGE :$A11 Australia and New Zealand. All other destinations please inquire
$A11
TOTAL
 		 

Purchase Order No. (if institutional order): number & date
 		 
For upgrades: Current Stata licence number
 		 
For GradPlan(circle) Student  or Staff
 		 
To claim GradPlan/Academic status: State academic/Student ID No.
 		 
Operating System: (One of these must be circled) <--<--<--<-

Windows ( Windows 2000, Windows 2003 Server Windows XP and Vista - Windows 32 bit, Windows(64-bitx86-64), Windows(64-bit Itanium)) ,
Macintosh OS X 10.4 and greater,
Unix HP-UX, AIX(32 bit) AIX(64bit), Linux(32-bit Intel), Linux(64-bitx86-64), Linux(64-bit Itanium), Solaris(64-bit SPARC) Solaris(64bit x86-64)
Name/address of purchaser (required for registration of software)
First Name
 		 
Surname
 
 		 
University 
(Must be complete for GradPlan purchase)
 		 
Department  
(Must be complete for GradPlan purchase)
 
 		 
Address
 		 
 
Postcode
 		 
Phone
(       )
Fax
 (       )
Email
 		 
  Name/address for delivery (if different from purchaser)

Name

 

Address

 
  Name/address for invoice (if different from purchaser)

Name

 

Address

 
Cheques and direct debit
 Please make payable to Survey Design and Analysis Services Pty Ltd. Cheques should be in Australian dollars drawn on an Australian bank. You can make direct debit payments to our cheque account at any branch of Westpac (or Bank of Melbourne or Challenge Bank) or by online banking with a "pay anyone"; transfer. Please tell us that you have made the payment, and we will process your order as soon as we check that payment has been received at our bank. Our bank details are: Account name:Survey Design and Analysis Services Pty Ltd
BSB:033 050    Account number:143 027
Credit card payment

Type of card

Circle one:…Visa……MasterCard……

 

Card number

 

 

Name on card

 

Expiry date

 

Signature

 

Date