Name__________________________________________________________________________
Street Address____________________________________________________
______________________________________________________________
Mailing Address (If different)____________________________________________
______________________________________________________________
Telephone: ___________________________(BH)_________________________
Barter Card, Personal Cheque, Bank Cheque and Postal Note on
Australian Banks only.
| |
Personal
Cheque |
| |
Credit Card |
| |
American
Express |
| |
Diner's
Club |
|
| Number of Sets |
|
| Price per set |
$A
10.00 |
| Postage
$5.00
(International $10.00) |
|
| Total |
|
|
Name on Credit
Card______________________________________________
Signature
