Point of Relief - Order Request Form
After you fill out this order request, we will contact you to confirm the order and supply an invoice.
Please contact us on 0414 633 837 or at pointofrelief@gmail.com if you have any questions.
Are you a new or existing customer? *
How many Points of Relief would you like to order? Prices are excluding GST *
Colours: Red, Purple, Green, Yellow, Pink and Blue
Colour Option - If you'd like a different colour breakdown than the same of each colour, please instruct below
Your answer
Clinic Name and Address for delivery *
Your answer
Contact Name *
Your answer
Phone number *
Your answer
E-mail *
Your answer
Preferred contact method *
Questions and comments
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