Intellia Limited

Bank Deposits

Pay by Bank Deposit

Intellia Ltd (Auckland)

Bank Account No:

ANZ 010202-0067246-00

[Note: Please ensure to include your customer name as reference for the money transfer.

Additionally it would be helpful if you could send us an e-mail informing us of your payment and the what order the payment is intended for]

Buy

Dear Valued Customer !

Thank you for your interest in our products. Please fill in the buyer's form below to complete your purchase.

Buyer's Form

Note: Fields marked with * are required.

Product Details

Please enter the Product (or Service) Name:*


Please enter the Product (or Service) Code:*
	Products and Product Codes

How many Units of this Product (or Service) do you want to Order ?
Order Quantity:*



Mailing Details

Addressed To:*

Street Address:*

City:*

Post Code:

Country:*



Buyer Details

Your Full Name:*

Your Organisation:	(if applicable)

Your Telephone:*	(including country code)

Your E-Mail:

Are you the actual Recipient of the purchased item(s) ?*
	Yes No



Credit Card Details

Cardholder's Name:*

Credit Card Type:*	(please select)

Credit Card Number:*

Card Expiry Date:*

Confirm your Payment Sum in NZ$:*
	Forex Rates


Additional Notes:
If you would like to add any additional notes relating to this payment, please add them here.




Note: Once your payment has been received we will ship your order, within 24 hours, from Auckland (New Zealand) to your destination anywhere in the world. However, please note that some of our services apply to locations within New Zealand only, and some of our products are for sale to customers living in the USA only; where this applies it is stated next to the item for sale. All our physically mailed items that we send out to our customers will be postal insured and issued with an international delivery tracking number.