To order by mail, please print and use this Order Form.
| MAIL ORDERS ... | PHONE ENQUIRIES ... | EMAIL / ENQUIRIES |
| Bernard Bolan PO Box 600 Beechworth, VIC, 3747, Australia |
(61) 02 9746 5995 or (61) 03 5728 2877 |
bolan@iprimus.com.au |
| PRODUCT | AUSTRALIA | OVERSEAS |
| CD: |
$30
|
email for details
|
|
TITLE |
QTY |
VALUE |
|
TOTAL DUE: |
PAYMENT DETAILS (Please tick as appropriate)
Cheque or money order to be made payable to BERNARD BOLAN
q Money Order is enclosed POSTAGE DETAILS(Please print clearly)
q Cheque is enclosed
Name:
________________________________________________________
Address:
________________________________________________________
________________________________________________________
Town/City:
__________________________ State __________ Code _______
Contact telephone number: ( ____ ) ___________________________
Email: ___________________________________________________
