| PLEASE SEND ME |
|
| The NFM Contraception Kit @ $159.95 $AUD Australian Dollars |
$ 159.95 |
| Quantity |
|
| Sub-Total [if purchasing more than 1 Kit] |
|
| Postage and Handling [1 only charge for any quantity] |
$ 8.00 |
| TOTAL PAYMENT in $AUD |
| ................................................. | ...................................................................................................................... |
| NAME | . |
| ADDRESS | . |
| CITY / STATE/ POSTCODE | . |
| COUNTRY |
. |
| DAYTIME PHONE or EMAIL | . |
| International DRAFT in $AUD* |
. |
| PAY by CREDIT CARD | . |
| TYPE OF CARD [circle] | MasterCard / Visa [automatically
billed in your own currency]* |
| NAME AS ON CARD | . |
| CARD NUMBER [16 digits] | . |
| EXPIRY DATE [mm/yy] | . |
| SIGNATURE & DATE | |
POST TO:
or FAX TO:
(03) 5474 3243
NFMKits
81 Barker Road
North Harcourt
VIC
3450
AUSTRALIA
* International DRAFT in
Australian Dollars ONLY - purchase
these from your bank who will most likely charge a fee. It is
usually
a better option to pay by Credit Card which will be automatically
billed in your own currency at the rate of the day.
For exchange rates go to http://www.xe.com
and scroll to page bottom to convert your currency
**Privacy Statement:
your
details are only used to process this order,
and not given, sold or transfered in any way
to any other person or company for any purpose.