Dispense-O-Ring Order Form

Simply fill in the form below:

Dispense-O-Ring order form

Order Form Bangles

Full Name plus Surname *

Full name as per stated on ID

Phone *

Email *

Full Physical Address *

Suburb *

Province *

Postal Code *

Order Amount *

If you Selected Other please specify amount

Bangle Colors *

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Terms & Conditions

Agree

I have read the below terms & conditions and hereby agree to them.

After your order is placed please email or Whatsapp us your POP

Acc Name: Rossouwtech
Acc Holder: Christo Rossouw

CAPITAC BANK
ACC Nr: 169 533 8225 (Savings)
Branch Code: 470010

FNB BANK
Acc: 6273 866 1588 (Cheque)
BR: 250655

MOST IMPORTANT
REF: Your Name & Order Nr.

SEND POP TO

SMS: 082 544 6122

*Your order number will always start at 1, your next order will be 2, then 3 etc.
Your 1st order number will look like this:
( Agent Name 1 )

*Orders will only be processed after we have received the POP.

Terms & Conditions apply | Subject to Change