| JEANETTE WORMALD
ORDER FORM (print out and send with order)
Mr/Mrs/Ms: .............................................................................................. Address: ................................................................................................... Phone: ..................................... Fax: ....................................... email: ........................................................................................................ Enclosed is a ............
cheque ................ Money Order OR please charge my: ............... Bankcard ................ Mastercard ..................... Visa (sorry, credit card orders only within Australia) Card no. ______ ______ ______ ______ Name on Card: Signature: ____________________________
Expiry Date: ______/______
TOTAL (includes postage & packaging) $___________ ENQUIRIES: lindene@riverland.net.au |
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