PROSPECT ELECTRICAL WHOLESALERS

o r d e r f o r m
Interim only - to be confirmed

If you know the products, code numbers and quantities you want...
please complete this simple order form...
and then click the "SEND" button at the bottom of the page.
We will contact you to confirm availability, pricing and delivery

Please be sure to complete the boxes with the red marker so we can get back to you.
The other boxes are optional.

Contact form

( * required elements )

* First name

* Last name

* e-Mail address

* Phone
(bus hours)

*Town or Suburb

*Organisation

*Position in
organisation

*Order Number

Phone
(after hours)

Mobile phone

I would like
PROSPECT
to contact me
to confirm

Please click to tick this box

I would like
to order
these items

Item 01	Description	Code	Qty
Item 02	Description	Code	Qty
Item 03	Description	Code	Qty
Item 04	Description	Code	Qty
Item 05	Description	Code	Qty

When you've completed the form
please click this "SEND" button

Thank you

OUR BUSINESS IS BUILT ON SERVICE AND DELIVERY

For more information, visit our office and warehouse,
or give us a call, or use our On-Line Contact Form

PROSPECT ELECTRICAL WHOLESALERS PTY LTD
20 Forge Street Blacktown NSW 2148
tel:02 9671 1233 - fax:02 9831 3570