orderform

Securefax Orders
PRINT THIS FORM - FILL IN ALL THE DETAILS - FAX TO: 00 61 8 9382 4080

Flame Ministries International - ABN 92 130 821 513

Flame Ministries International E-Mail Orders

ORDERS TAKEN BY SECUREFAX
SENDING PAYMENT BY FAX KEEPS YOUR CREDIT CARD DETAILS SECURE.

No Fax? - Try Western Union.

Name and Address for Shipping & Confidential Records - Please Print Clearly with Black Ink.

Name:...............................................................................................	Your Phone >	..................................................................
Address:..........................................................................................	Your Fax >	..................................................................
...........................................................................................................	Your Mobile >	..................................................................
...........................................................................................................	Your E-Mail >	..................................................................
Country:...........................................................................................	Post/Zip Code >	..................................................................

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NOTE: If shipping is to a PO BOX, please include a Home Address for Credit Card Purposes.

Home Address:....................................................................................................................................................................................

Please supply the under mentioned product quantities
and charge me at the stipulated Australian Price including Postage and Handling.
Click here to calculate your payment at today's current exchange rates. YAHOO CURRENCY EXCHANGE

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To check your #catalogue number, product name and price details before faxing > Back to Shop
For extra products reprint form and complete the details.

Grand Total

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Please Charge My Credit Card (Tick Box) > /...../ BankCard - /...../ Visa - /...../ MasterCard

Credit Card No: /...../...../...../...../ - /...../...../...../...../ - /...../...../...../...../ - /...../...../...../...../

Expiry Date: ......../......../........ Name on card....................................................................

Signature:................................................... / Print and Fax this form to: 00 61 8 9382 4080

INTERNAL USE ONLY:
Date of Purchase......................Receipt No..............Order Taken By..................................Date Posted..........................

flame ministries international Head Office:Suite 6, 186 Hay Street Subiaco 6008 Western Australia.
Postal Address: PO BOX 8133 Subiaco East 6008 Western Australia.
Phone: 00 61 8 9382 3668. Fax: 00 61 8 9382 4080. E-mail: fmi@flameministries.org