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Return to Petals & Patches
PETALS & PATCHES
ORDER FORM FOR MAIL AND FAX
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P.O. Box 558, Altona, Victoria, Australia 3018 | Return to Petals & Patches |
| ABN: 16 804 843 766 | ||
| Phone : (03) 9315 6877 International : +61 3 9315 6877 | ||
| e-mail : info@petalsandpatches.com |
| *Name: | |||
| *Address: | |||
| *Town: | *Postcode: | ||
| *State/Province: | *Country: | ||
| #Telephone: | ¤e-mail: | ||
| Product No. | Title | Quantity | $AUD Price | Subtotal : | $ |
| See the Order Page for Postage & Handling costs. | P & H : | $ | |||
| Make all cheques/money orders payable to Petals & Patches | Total : | $ | |||
| Date of Order : | __ __ /__ __/__ __ __ __ | ||
| Credit Card Details : (Circle your card type:) |
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| Name on Card : | |||
| Card No. : | __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ | CVV No : ? (Card verification:) |
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| Expiry Date : | __ __ /__ __ | ||
| Amount : | AUD $ | ||
| Signature : | |||
