Burgundy Raggies (Printable Order Form)

BURGUNDY RAGGIES PRINTABLE ORDER FORM

1885 GRAY ROAD, TIMMERING, VICTORIA, 3561 AUSTRALIA

PHONE: 03 5484 6224 FAX: 03 5484 6248

NAME:

ADDRESS:

COUNTRY:

POST/ZIP CODE:

PHONE NO: FAX NO:

EMAIL:

CREDIT CARD: EXPIRY DATE:

DATE ORDERED:

	SUB TOTAL
PLEASE EMAIL FOR POSTAGE RATE	POSTAGE
PAYMENT OPTIONS:
Direct Debit
Credit Cards (Visa/Mastercard)
Money Orders made payable to Burgundy Raggies in (AUD) only
Cheques (Australian) made payable to Burgundy Raggies
	TOTAL PAYABLE

PLEASE CIRCLE BOX FOR YOUR PREFERRED METHOD OF PAYMENT
DIRECT DEBIT	CREDIT CARD	MONEY ORDER	CHEQUE

(Burgundy Raggies will advise Direct Debit Account details if applicable)

ORDERS WILL NOT BE DISPATCHED UNTIL PAYMENT IS RECEIVED & CHEQUES CLEARED