Mail/Fax Order Form

Please print this page and write in your details. Thank you.

Fax to +64 6 278 4291 or Send to: Framing Gallery 41 High St HAWERA NEW ZEALAND

PERSONAL DETAILS:

Title:	(Mr/Mrs/Miss/Ms)
First Name:
Surname:
Address:
Daytime Telephone:
Email Address:

ORDER DETAILS:

Product Code	Product Name	Quantity	Price
		Delivery
		TOTAL

METHOD OF PAYMENT:

I enclose a Cheque/International Money Order made payable to the Framing Gallery for $_______________ Credit Card Type: Mastercard / Visa / American Express / Diner's Card Credit Card Number: |___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___| Expiry Date: ____/____/  Name on Card: _______________________   Signature: _________________