| Qty | Product Name | Item Code* | Size | Price $ |
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*About Item Codes: Item codes are the little [number] under the items name. Subtotal: |
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Postage Charges (Australia Only) Reg'd Postage & Packing: |
$9.35 AUD | |||
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TOTAL: |
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Your Billing / Delivery Details - Required
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Billing Details |
Delivery Details (if same as billing, leave blank) | ||
| Name | Name | ||
| Address | Address | ||
| Suburb/Town | Suburb/Town | ||
| Postcode | Postcode | ||
| State | State | ||
| Country | Australia | Country | Australia |
| Telephone | Telephone | ||
Credit Card Details - Card
No. : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Expiry: _ _ / _ _
Name on Card: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Circle Card Type: VISA / Mastercard
Please Sign Here: I authorise payment of the amount of: $__________ on my _________ card. I understand this payment will be billed through Paymate (this will appear on your statement) and an additional fee of 3% + 0.50c* applies to my order total. *Plus GST on the fee.
Signed: _________________ Print Name: _________________
Please PRINT this order form, then fill in your order and details and
POST to our Address Below
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Australian Native T-Shirts 63 Duke St Forestville 2087 NSW Australia |