Order Form

Payment options: - Online Ordering: Complete the order form below and click the Send Order button at the bottom of the page, you will be taken to a new page where you can choose the method of payment with all relevant details explaining how.

For online payments we use Veripay as our secure payment window. Once you enter your details on the next page a new pop-up window will appear (please ensure you allow pop-ups for this transaction). In this safe payment window you can enter your creditcard details for payment. You will be emailed a receipt once your payment is successful. Our office will then process your order and email a copy of the invoice to you prior to dispatch.

Veripay offers 128-bit SSL and 1024-bit encryption. This ensures maximum security. Details at www.xilo.com.au

Please note only MasterCard and Visa are accepted.

DELIVERY INFORMATION:

$7.50 Australia wide delivery charge is applicable to all orders within Australia.

Unfortunately we do not accept orders for delivery outside Australia at this point in time due to quarantine regulations.

Billing Information
First name:*
Last name:*
E-mail:*
Would you like an email confirmation of your order?:

Shipping Information
Is the shipping name the same as the billing name?:
First name:
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Is this order a gift?:
Address:*

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Postcode:*
Phone number:*

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Additional Information:

O R D E R D E T A I L S

The order form below is divided into products. To review the product whilst in the order form, click on the product link (underlined heading). To return to this order form click your back button located at the top left of your screen.

Qty	CLASSIC CORD WHEAT BAGS	Unscented	Lavender	COLOUR	Price	Total
	SRR - Small Rectangle Regular (15cm x 30cm)	unscented	lav		$17.95	$
	SRR - Small Rectangle Regular (15cm x 30cm)	unscented	lav		$17.95	$
	SRR - Small Rectangle Regular (15cm x 30cm)	unscented	lav	LEOPARD	$21.95	$
	SRS - Small Rectangle Sectioned (16cm x 30cm)	unscented	lav		$19.75	$
	SRS - Small Rectangle Sectioned (16cm x 30cm)	unscented	lav		$19.75	$
	SRS - Small Rectangle Sectioned (16cm x 30cm)	unscented	lav	LEOPARD	$23.75	$
	LRR - Large Rectangle Regular (17cm x 37cm)	unscented	lav		$21.50	$
	LRR - Large Rectangle Regular (17cm x 37cm)	unscented	lav		$21.50	$
	LRR - Large Rectangle Regular (17cm x 37cm)	unscented	lav	LEOPARD	$25.50	$
	NB - Neck Bag hanging (17cm x 60cm)	unscented	lav		$36.95	$
	NB - Neck Bag hanging (17cm x 60cm)	unscented	lav		$36.95	$
	NB - Neck Bag hanging (17cm x 60cm)	unscented	lav	LEOPARD	$42.95	$
	NBV - Neck Bag with velcro (17cm x 60cm)	unscented	lav		$38.95	$
	NBV -Neck Bag with velcro (17cm x 60cm)	unscented	lav		$38.95	$
	NBV -Neck Bag with velcro (17cm x 60cm)	unscented	lav	LEOPARD	$44.95	$
	LW - Lumbar Wrap (17cm x 83cm)	unscented	lav		$51.95	$
	LW - Lumbar Wrap (17cm x 83cm)	unscented	lav		$51.95	$
	EXT - Extension Belt				$5.50	$
Qty	CLASSIC CORD WHEAT BAGS	Unscented	Lavender	COLOUR	Price	Total
	SB - Shoulder Back (52cm x 43cm)	unscented	lav		$64.95	$
	SB - Shoulder Back (52cm x 43cm)	unscented	lav		$64.95	$
	SB - Shoulder Back (52cm x 43cm)	unscented	lav	LEOPARD	$72.95	$
	CO - Classic Oval (26cm x 33cm)	unscented	lav		$35.95	$
	CO - Classic Oval (26cm x 33cm)	unscented	lav		$35.95	$
	TS- Therapy Small (30cm x 30cm)	unscented	lav		$35.95	$
	TS- Therapy Small (30cm x 30cm)	unscented	lav		$35.95	$
	TS- Therapy Small (30cm x 30cm)	unscented	lav	LEOPARD	$41.95	$
	TM - Therapy Medium (30cm x 40cm)	unscented	lav		$48.95	$
	TM - Therapy Medium (30cm x 40cm)	unscented	lav		$48.95	$
	TL - Therapy Large (30cm x 60cm)	unscented	lav		$59.95	$
	TL - Therapy Large (30cm x 60cm)	unscented	lav		$59.95	$
	CS - Classic Spinal Sectioned (16cm x 60cm)	unscented	lav		$38.95	$
	CS - Classic Spinal Sectioned (16cm x 60cm)	unscented	lav		$38.95	$

Qty	WHEAT BAG COVERS			COLOUR	Price	Total
	MPRC - Taslon Cover (16cm x 30cm)				$8.00	$
	WSPC - Taslon Cover (30cm x 30cm)				$11.50	$
	WNBC - Taslon Cover (17cm x 60cm)				$11.50	$

Qty	LITTLE MEN WHEAT BAGS			COLOUR	Price	Total
	LP - Little People Wheat Bags 28cm x 26cm	unscented	lav		$29.95	$
	LP - Little People Wheat Bags 28cm x 26cm	unscented	lav		$29.95	$

Qty	COW FAUX FUR WHEAT BAG	Unscented	Lavender	COLOUR	Price	Total
	COW - Cow Faux Fur Wheat Bag 17cm x 37cm	unscented	lav	Cow Faux Fur	$24.95	$
	COW - Cow Faux Fur Wheat Bag 17cm x 37cm	unscented	lav	Cow Faux Fur	$24.95	$

Qty	DISCONTINUED RANGE			COLOUR	Price	Total
	MPL- Multi Purpose Long Wrap (17cm x 60cm)	unscented	lav		$42.50	$
	MPL- Multi Purpose Long Wrap (17cm x 60cm)	unscented	lav		$42.50	$
	WM - Mini Wheat Bag (15cm x 15cm)	unscented	lav		$12.95	$
	WM - Mini Wheat Bag (15cm x 15cm)	unscented	lav		$12.95	$

Qty	JOINT WRAP WHEAT BAGS	Unscented	Lavender	COLOUR	Price	Total
	WWS - Joint Wrap Small (13cm x 28cm)	unscented	lav		$43.95	$
	WWS - Joint Wrap Small (13cm x 28cm)	unscented	lav		$43.95	$
	WWM - Joint Wrap Medium (13cm x 42cm)	unscented	lav		$48.95	$
	WWM - Joint Wrap Medium (13cm x 42cm)	unscented	lav		$48.95	$

Qty	HAND AND FEET	Unscented	Lavender	COLOUR	Price	Total
	HM - Hand Mit (16cm x 32cm)	unscented	lav		$35.95	$
	HM - Hand Mit (16cm x 32cm)	unscented	lav		$35.95	$
	WC - Wheat Cylinder (28cm x 40cm)	unscented	lav		$48.95	$
	WC - Wheat Cylinder (28cm x 40cm)	unscented	lav		$48.95	$
	PS - Polar Fleece Slippers	unscented	lav		$64.95	$
	PS - Polar Fleece Slippers	unscented	lav		$64.95	$

Qty	MAXI WRAP WHEAT BAG	Unscented	Lavender	COLOUR	Price	Total
	MWS - Maxi Wrap Small	unscented	lav		$43.95	$
	MWS - Maxi Wrap Small	unscented	lav		$43.95	$
	MWM - Maxi Wrap Medium	unscented	lav		$46.95	$
	MWM - Maxi Wrap Medium	unscented	lav		$46.95	$
	MWL - Maxi Wrap Large	unscented	lav		$48.95	$
	MWL - Maxi Wrap Large	unscented	lav		$48.95	$
	WMWSTRAPS - Maxi Wrap Extra Strap Small				$13.50	$
	WMWSTRAPM - Maxi Wrap Extra Strap Medium				$16.00	$
	WMWSTRAPL - Maxi Wrap Extra Strap Large				$18.50	$

Qty	PATTERNED WHEAT BAG	Unscented	Lavender	COLOUR	Price	Total
	Patterned Wheat Bag (15cm x 45cm)	unscented	lav		$34.95	$
	Patterned Wheat Bag (15cm x 45cm)	unscented	lav		$34.95	$

Qty	REMOVABLE SATIN COVER SET	Unscented	Lavender	COLOUR	Price	Total
	WCS - Removable Cover Set (14cm x 44cm)	unscented	lav		$27.95	$
	WCS - Removable Cover Set (14cm x 44cm)	unscented	lav		$27.95	$

Qty	EYE PILLOWS	Unscented	Lavender	COLOUR	Price	Total
	Eye Pillows	unscented	lav		$14.95	$
	Eye Pillows	unscented	lav		$14.95	$
	Eye Pillows	unscented	lav		$14.95	$

Qty	DELIVERY CHARGE			Colour	Price	Total
	FREIGHT CHARGE FOR AUSTRALIA				$7.50	$
					TOTAL	$

I will pay for my order by:

Credit card online

Credit card by phone

Cheque/Money Order

Direct Deposit

C L I C K B E L O W T O S E N D O R D E R

(if this order is for outside of Australia - DO NOT PROCEED - due to quarantine regulations we can not export at this time)

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