1821 Pakowhai Road
R.D.  3
Napier  4183
New Zealand

Phone & Fax:  +64  6  878  1260

Contact:  Sherelyn Whiteman

Order Form :  Order by phone, fax or mail

 
Name:   (Please print)   ....................................................................................   Date:  ..................................
Address:  ..................................................................................................................................................
City:   ...................................................................     State / County:   ......................................................
Zip Code:   ............................................................ Country:   ..............................................................
Telephone:  ......................................................(Day)     ...............................................................  (Evening)
Email:   ................................................................... Fax:   ...................................................................
       

Office

Use

Code

Description / Design Title

Qty

Price

Invoice #

B/O

           
           
           
           
           
           
           
           
           
           
           
Shipping & Handling Charges:

Sub Total

 

Account #

Within NZ  ......   $5.50

Shipping  & Handling

   
International   .....   $10.00 up to 100 grams, thereafter actual costs

Total

   
Method of Payment: [      ]   Cheque enclosed
  [      ]   Please charge my Credit Card :   [      ]   Visa           [      ]   Mastercard
Credit Card #:   .............................................................................................................................................
Name:   (as it appears on card)   ...........................................................................................................................
Expiry Date:   ........................................     Signature: ...................................................................................