ANTaR MERCHANDISE ORDER FORM

PLACING ORDERS
Orders can be placed by mail, fax or phone. Please allow 1-2 weeks for delivery within Australia, and 3-4 weeks for delivery overseas. Choose from the following:
Mail:

Print out this form from your browser, fill it in and send it, along with a cheque OR postal order (payable to 'ANTaR'), OR credit card payment details to:
ANTaR
PO Box 1176
Rozelle, NSW 2039
Fax: Print out this form from your browser, fill it in along with your credit card details and fax it to: (02)95556991
Phone: Call ANTaR on (02) 9555 6138 and have your order and credit card details ready.

CUSTOMER DETAILS
Name:    ____________________________________________________________________
Address:    ____________________________________________________________________
   Suburb_____________________________State__________P/code______________
Phone:    ________________________       Email:   ___________________________________
Payment method:       Cheque / postal order         Credit card (fill in details below)

CREDIT CARD PURCHASE DETAILS
Date:   ____________________           Purchase amount:   $_______________
Card type:    Visa       Mastercard       Bankcard       Amex
Card number:    __ __ __ __   __ __ __ __   __ __ __ __   __ __ __ __   Expiry date:  __ __ / __ __
Name on card:    _______________________________________________________________

PRODUCT QUANTITY PRICE
TOTAL
1.      
2.      
3.       
4.      
5.      
6.      
EXTRA POSTAGE (if applicable, eg overseas orders)    
DONATION AMOUNT    
TOTAL     

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