www.purebaby.co.nz

Order Form

Press ctrl-p to print.

1.
Name: _______________________
Street Address: _______________________
Suburb: _______________________
City: _______________________
Country: _______________________
Email Address: _______________________
Telephone: ______________

Send to: Purebaby Ltd
P.O Box 70 077
Ranui, Auckland 0612
New Zealand
Fax: + 64 9 833 3126
Phone: + 64 9 833 9064
2.
Name: _______________________
Delivery Address
(if different to above):
 		_______________________
Street Address: _______________________
Suburb: _______________________
City: _______________________
Country: _______________________
Please Gift Wrap
Message for card:

____________________

____________________

heard about purebaby through:
fair
fete
friend
internet
advertisement
other:
____________________


3. Payment
Visa
Mastercard
Bankcard

Account Number
Cardholders Name: _______________________
Expiry Date: ___/___

Please note that you will be billed by Southern Alps New Zealand Ltd.

Cheque or money order enclosed. Please make cheques out to Southern Alps Ltd.

Item Description Embroidery Size Quantity Total
         
         
         
         
         
         
      Courier $3.50
      Total