Purchase Order No:

    Date (YYYY-MM-DD):

    Delivery Address:

    Invoice Address:

    Part No: Quantity: Description

    Name *



    A confirmation email will be sent to this email address.


    Please Provide a quote only

    How to place an order with Air & Gas Industries

    Orders are placed once we confirm all the details you provided.

    This form serves as a first point of contact, and gives us the information we need to have an informed discussion with you around what you want to order, and how we can add value to your project.

    Call our office on 07 3271 5899 if you want to speak to one of our sales representatives.