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If you would like to make an order, please print this form and fax it back to Cheryl on +61 8 8733 1011 or send to Bankhouse Quilts, 70 George Street, Millicent, South Australia, 5280, Australia. Alternatively, orders can be emailed through the email function above. Feel free to contact Cheryl with any queries by phone on +61 8 8733 1011. |
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pricing in Australian currency. Shipping will be arranged at purchasers request and expense. |
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Order Form |
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Mr/Mrs/Miss/Ms Name:____________________________________
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Address: _________________________________ _________________________________________ _________________________________________
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Phone Number:_______________________________ | ||||||||
| Email:______________________________________ | |||||||||
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Fax Number:______________________________
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Wishing
to pay by:
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Master
Card
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Bank
Card
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Diners
Club
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American
Express
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Visa
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Cheque
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( please circle one ) |
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Name:_______________________Credit Card No._______________________ Exp. Date____________ |
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Product:__________________________ Code:____________ Quantity:__________Price:$___________ Product:__________________________ Code:____________ Quantity:__________Price:$___________ Product:__________________________ Code:____________ Quantity:__________Price:$___________ Product:__________________________ Code:____________ Quantity:__________Price:$___________
TOTAL AMOUNT:$ __________________________ |
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Any Comments: ______________________________________________________________________ ______________________________________________________________________________________ |
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