Aussie_Specials-Order-Form

CREDIT CARDS ONLY ACCEPTED (not UK Bankers or Debit Card).

SECURE AUSTRALIA SPECIAL DVD PRICE ORDER ALL FOUR FOR $75.00 GET 1 FREE or $25.00 each - Climate Change - The God Factor, Climate Change & Creation & Are you Born Homosexual?

Prices shown in local currency as of April 2010 A.D. Subject to change without notice. Allow 2 -3 weeks for delivery.

Welcome to the easy FIVE step ORDER process.

1 Client Details
* Date:
Title:
* First Name:
* Surname:
Company:
Position:
2 SHIPPING DETAILS
* Address:

* Suburb:
* State:
* Country:
* Post Code:
3 CONTACT DETAILS
Phone No.:	A/H Phone:
Fax:
* Email:

4 ORDER DETAILS
* Qty	* Item	* Click arrow for Product title and Prices. (all prices inc. GST)	Post Free
	Item 1		1 DVD, $25.00 each All 4 for the price of $75.00 *GET 1 FREE*
	Item 2
	Item 3
	Item 4
	Item 5

5 PAYMENT DETAILS
* Value:
* Total Amt payable:
* Card Type:
* Card Number:
* Expiry Month:	/ Year:
* Name on Card:
* For security purposes:		Please turn your credit card over and copy the last three digits in text box below.

PURCHASE STATEMENT: Please supply the products I have selected above. For payment, I authorise you to debit the above credit card for the total amount. I understand I will be contacted by phone, fax or e-mail confirming order. Following confirmation, the goods will be shipped to me.

PLEASE RECHECK THAT ALL THE BOXES MARKED WITH * HAVE BEEN FILLED IN BEFORE YOU PROCESS YOUR ORDER THEN CLICK