Date:
LastName:
FirstName:
Address:
Suburb: Home:
State: Work:
Postcode: Mobile:
☐
Email:
L1DEALER
StoreName:
SalesPerson:
Phone:
Email:
Address:
Suburb:
State:
Postcode:
SPECIALINSTRUCTIONS
PAYMENTOPTIONS
Nameoncard:
Signature:
CardNo:
Expirydate:
SecurityNo:
L1distributionishandledbyanMIdistributorandbyBosePtyLtd.
Mr/Mrs/Ms/Other:
Creditdetailsareusedonlyfortheinitialpurchaseandarethendestroyed.Viewourprivacypolicyonlineatwww.bose.com.au
(Pleaseinclude fullnameinthetransactiondetailsandemailtransactionconfirmationtoausinfo@bose.com)
AllL1PersonalizedAmplificationSystem™equipmentispurchasedbythecustomerdirectlyfromBosePtyLtdandissubjecttotheBosePtyLtdwarrantyandtermsandconditionsofpurchase.
Pleasedebitmycreditcardtotheamountof:$
*Pleasenote,orderswillnotbedispatcheduntilBosePtyLtdreceivesconfirmationofdepositofclearedfunds.
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PLEASETEAR‐OFFANDDESTROYONCETHETRANSACTIONHASBEENAPPROVED.
Faxto0800755500oremailausinfo@bose.com
EFT:WestpacBanking
Corporation.BSB:032079A/CNo:126402A/CName:BosePtyLtd
Cheque:PleasemakechequepayabletoBosePtyLtd.
CreditCard:☐Mastercard☐AmericanExpress☐Visa
ProfessionalSystemsDivision.Design|Performance|Support
Bose®L1®PersonalizedAmplificationSystem™|OrderForm‐NewZealand
CUSTOMERINFORMATION
IwouldliketoreceiveBoseproductandpromotionupdatesviaemail
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