PLEASE PRINT THIS FORM. Name ______________________________________ Address ____________________________________ ___________________________________________ ___________________________ P/code _________ Telephone __________________________________ Email ______________________________________ Item Description Size Colour Qty AU$ Total Eg: womens      full briefs 14 natural   2 19 38.00                                                                                                                                     Postage & Handling - 5.00 TOTAL (includes GST)   HOW YOU CAN PAY  Direct deposit: o Bendigo Bank                              BSB 633 000 A/C 122122708  Postal Order o       Visa          o    Cheque      o           Mastercard    o                      Bankcard        o Credit Card Number    Expiry Date _____/_____  cccc cccc cccc cccc  Name on Card _______________________________  Signature ___________________________________
Please post this order form to: Blessed Earth, Shop 7-8, 128 Main St, Montville Q.L.D. 4560 or fax to: 07 5478 5889 Thank you for supporting Blessed Earth and the organic cotton industry.