Online Order Form

The SAS FINANCIAL YEAR ACCESS FEE is payable once per financial year and must be paid before placing your first order in each financial year.
Delivery services are not covered by the SAS FINANCIAL YEAR ACCESS FEE. Make sure you have PREPAID for postage and handling.

Membership Number:*

First Name:*

Last Name:*

Email:*

Date of Birth:*

Medicare Card Number:*

Medicare Card Expiry:*

Telephone Number:*

Mobile Number:

Order for month of:*

Pick up or Post:*

CAV holds each client’s POSTAL ADDRESS on file.
Posted parcels will be dispatched to that address.
Do not place this order if that address needs to be changed.

Notify CAV of the client’s new address by phone, post or email.
Place an order only after receiving CONFIRMATION of the updated address on file.
CAV accepts no responsibility for a parcel dispatched to the wrong address if the above instructions have not been followed.

Special instructions: not to be used to notify a CHANGE OF ADDRESS

Code Number

Quantity

Brand Name,Item or Description

Note: To obtain more than the monthly allowance, a signed Extra Supply Form must be produced

DOUBLE ORDERS >>> Please include DOUBLE THE POSTAGE FEE

ColoVic

Online Order Form