Place Your Order

Monthly Order Forms

A $18.00 monthly fee applies for postal deliveries ($25 for two month orders).

Orders should reach us prior to the 1st day of the order month. Goods will then be available for either pick up at our Arundel premises, or dispatched by postal delivery ( if so stipulated on the order form with the prepaid $18.00 parcel post fee submitted or $25 for two month order) within the first week of the supply month.

Instructions:

If payment is not required with your order, please feel free to fill in our online order form below. Make sure you fill in all relevant fields so that we can correctly process your order with no delays. If no payment is necessary just fill in the required credit card  fields with the word Nil.

If you need to make a payment by credit card insert with your order, or please phone the Association (07 5594 7633) PAYMENT CHOICES: EFT PAYMENTS: IMPORTANT; PLEASE ALWAYS INCLUDE THE MEMBERS NAME AS A REFERENCE; EFT: BSB: 484799 A/C 100 119 735 A/C NAME - GOLD COAST OSTOMY ASSOCIATION INC


    PLEASE SELECT

    POST:PICK-UP:

    BRAND

    PRODUCT
    CODE NO.

    PRODUCT DESCRIPTION
    (BAG, POUCH, WAFER, FLANGE, ETC)

    PACKS
    REQUIRED

    Payable Items
    (Tapes,etc,)

    1.

    $

    2.

    $

    Total $

    PAYMENT CHOICES: EFT PAYMENTS: IMPORTANT: PLEASE ALWAYS INCLUDE THE MEMBER'S NAME AS A REFERENCE!

    EFT:

    BSB: 484799
    A/C:
    100 119 735
    A/C NAME:
    Gold Coast Ostomy Association Inc.

    If you select 'PICK-UP' you do not need to fill in your credit card details.

    CREDIT CARD:

    VISAMasterCard