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Pepi-Pod® Purchase Authority Form

This form is now a pre-requisite for all purchases. Once received we will process your order. This system protects against unauthorised purchasing and enables easy tracking of orders between your agency and ours. Thank you.

Purchase Authority
Number or Name:   (Required)
This is either a number issued by your agency to authorise your purchase, or it is the name of the person with purchasing authority. 
          A. Complete Pepi-Pod® sleep space package 





Regular size (for use in homes, supplied with mattress bedding and education materials, boxed in sets of 5, minimum order 30)

Total quantity   

Supplied monthly    quarterly     all at once

Instalment quantity               (specify if 'other')  


  • We want to ensure timely supply to you and avoid emergencies for you when your stocks are low.
  • New orders can take 4-6 weeks to process due to the intermittent need to restock component items (merino, mattresses, linen, pods). 
  • A monthly schedule of supply is most helpful to the timely supply for orders over 60.

          B. Separate replacement components  
  pods             (specify quantity)

mattresses   (specify quantity)

blankets       (specify quantity)              

sheet sets     (specify quantity)

           C. Other

Wahakura items         (please specify)

Hospital Pepi-Pod®   (quantity)

Other goods               (please specify)

Contact details  
Contact Person:
Billing Email:   (Accounts)
Delivery Information 
Delivery Address:

NB: This must be a physical address, not a PO Box.

Department or building:       

Street No:   and Name:



Delivery instructions: 
Delivery Contact: Name:   
 Any additional requests
Please specify:

                                    Programme provided by Change for our Children Limited