Puratap Mall Leasing Stands Order Form Stand Leads FormExisting Customer with Puratap ? Yes NoIs Booking for Next Day ? Yes NoIs this a Gift ? Yes NoFirst NameCompany NameInstallation AddressAddressSurburbPostal CodePhone / MobileEmailAlternate Contact NameAlternative Phone / MobileProduct TypeSelect Product TypeEasyFit 2300EasyFit 2300 (RW)GI-2600GI-2600 UpgradeGI-2700Total Price of Products - Incl. GSTChoose Type of Mixer Tap Standard Designer Separate Tap Imperial Chrome Designer Separate Tap Mark II Designer Separate Tap Standard Black Designer Separate Tap Standard Matte Gold Designer Separate Tap No Tap RequiredChoose Type of Separate Tap Classic 3 in 1 Tap Elegance 3 in 1 Tap Purity 3 in 1 Tap Clarity 3 in 1 Tap Modern 3 in 1 Tap Industry 3 in 1 Tap Black Industry 3 in 1 Tap Black Clarity 3 in 1 Tap No Tap RequiredInitial PaymentPayment Method- Select -No depositCashChequeCredit CardEFT POSPreferred Installation Date / TimeSpecial CommentsSubmit Form
