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au web: www.briggatemedical.com Customer Code: (if known) Name: Date: Contact: Order Number: Delivery Address: Telephone No: Fax No: email: Account Holders Trading Terms: All Invoices are due and payable within 14 days from the invoice date. Payment by Visa or Mastercard will be accepted, but ONLY at the time an order is placed. Members of the Public & Non Account Holders: Pre-Payment by Visa, Mastercard, Cheque or EFT Transfer requir.

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