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| I want... | |
| If 'other', please specify... | |
| Contact me by... | |
| Name (*mandatory) | |
| Street Address | |
| Postcode | |
| Postal Address (if different) | |
| Postcode | |
| Phone | |
| Facsimile | |
| Mobile | |
| Email (*mandatory) | |
| If ordering product, the following details are compulsory... | |
| Driver's Licence Number | |
| ABN | |
| Preferred method of payment | |
| Delivery Details (side gate, dog bites etc.) |
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Depending on your preferred payment method, you may need to print one of the following attachments when making your order.
Credit Card Authority Form
Credit Account Application Form
When complete please fax (5447 6907) or mail the form to:
Cooroy Mountain Spring Water, 314 Cooroy Mountain Road, Cooroy, QLD, 4563.
Residential
Choose from pre-delivery phone credit card or direct debit payments, funds transfer via the internet or if you prefer, our driver will accept your cash or cheque on delivery. Please call us to discuss the payment option best for you. We can also set up an automatic credit card payment facility. If you wish to do this either call us (5447 7577), use the above form to request the Credit Card Authority Form to be sent to you or simply click on and print the following attachment.
Credit Card Authority Form
Once completed please fax (5447 6907) or post the form to Cooroy Mountain Spring Water, 314 Cooroy Mountain Road, Cooroy, QLD, 4563.
Business/Commercial
In addition to the payment methods described above for our domestic customers, businesses can also apply for a 30 day credit account. Call us (5447 7577) or contact us through the above form and we will send you a Credit Account Application Form. Or click on and print the following attachment.
Credit Account Application Form
Once completed please fax (5447 6907) or post the form to Cooroy Mountain Spring Water, 314 Cooroy Mountain Road, Cooroy, QLD, 4563.
Delivery:
"We deliver either monthly, every two weeks or weekly depending on where you live; Maryborough, Hervey Bay, the Sunshine Coast, Brisbane or Ipswich. If you are outside the Maryborough, Hervey Bay, Sunshine Coast, Brisbane or Ipswich area, please call as special arrangements can be made. Our delivery service is FREE."

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