Natural Fertility Management Kits Order Form

Your Name: Today's Date: //2008

Your Address: Town: State:

Postcode: Phone: (day); (eve)

Email:Please send me the Moon Pads eNewsletter Yes; No

I wish to pay using my credit card Visa; MasterCard; Cheque; Money Order; PayPal**

Card Number: + last three digits on reverse side Expiry Date: /

Name as on credit card: Signature: ___________________________

Email:Please send me the Moon Pads eNewsletter Yes; No

How did you hear about us?

 

I want to order a Natural Fertility Management Kit for Conception @ $150

I want to order a Natural Fertility Management Kit for Contraception @ $150

 

(Price includes postage within Australia) Total of your order: AUD$

Now print out this form and mail it with payment by credit card, money order or *cheque. Please make all cheques and money orders payable to Moon Pads. Send to: Moon Pads, PO Box 118, SANDY BAY, Tas 7006 Australia.
Do NOT email your credit card details to me as this is not a secure site. Information to order via phone or email

** To pay using PayPal first write me a *text* email with your details and details of the products you want (This form is *not* suitable to email as it loses all the info you add!). I will then invoice you by email and give you the link to make your payment.

*Payment by Personal Cheque is available for Australian bank accounts only. Bank cheques in Australian dollars are acceptable from any country.

Prices effective 1 December 2006 and subject to change without notice.
Allow 2 weeks for delivery of your order. Enquiries: <info @ moonpads.com.au>

® MoonPads is the registered Trade Mark of Moon Pads ABN 47 602 059 395 <http://www.moonpads.com.au> Phone (03) 6223 5151