CSU Online Shop
Building 460 Valder Way
Charles Sturt University
Wagga Wagga NSW 2678
Tel: +61 2 6933 4980
Email: [email protected]
www.csu.edu.au/online-shop
School of Biomedical Sciences Paramedic Uniform Order Form
Student Name:
_______________________________________________________
Student Id:
_______________________________________________________
Email:
_____________________________Mob: _____________________
Postal Address: _______________________________________________________
Please print clearly as your first name will be embroidered onto your shirts, and we accept no responsibility for unclear writing.
CAMPUS (circle one)
Bathurst
Port Macquarie
Free pickup from Bathurst Mini-Mart
Online Student
OR
Description
Postage to my address – charges apply
Size
Quantity
Cost each
Compulsory Items
Paramedic Polo (Navy)
$37.00
(Polo must remain tucked in
Paramedic Pants (Navy)
$71.00
at all times, please consider
this when selecting size)
(please choose one option of
Safety Glasses Standard
N/A
$7.50
Safety Glasses Over
N/A
$7.50
Total Cost
Spectacles
safety glasses)
Optional Items
Postage up to 5 items
Knitted Jumper (Navy)
$55.00
Soft Shell Jacket (Navy)
$85.00
Soft Shell Jacket (Navy)
$58.00
(for over 5 items please contact us)
$10.00
Total
Please email both completed forms to [email protected]
Office Use Only
Date Order Received
_____________________
Received By Staff Member_____________________
Date Customer Quoted_____________________
Date Staff Ordered
_____________________
Order Number
_____________________
Customer Delivery Date
_____________________
Confirmation email
_____________________
Delivery email
_____________________
Tracking Number
_____________________
CSU Online Shop
Building 460 Valder Way
Charles Sturt University
Wagga Wagga NSW 2678
Tel: +61 2 6933 4980
Email: [email protected]
www.csu.edu.au/division/studserv/online-shop
CREDIT CARD PAYMENT AUTHORITY
To:
CSU Online Shop
Building 460
Valder Way
Charles Sturt University
Wagga Wagga NSW 2678
Name: ___________________________________________________________________
Address: __________________________________________________________________
_____________________________________________________________________________________________________
Mobile No/Email: ________________
Credit Card Type (please tick appropriate box)

Mastercard

Visacard
Amount
Card Number (all boxes must be completed)
   
Expiry date:
Card Check Value (last 3 digits on back of card)
 / 
Card Holders Printed Name: _____________________________________________
Card Holders Signature: ________________________________________________