ORDER FORM -
Block of the month – Mother Goose Nursery

PRINT - Complete and send to:

CONTACT:

JEANETTE

LYN’S FINE NEEDLEWORK

Suite 2 / 9 SEVEN HILLS ROAD

BAULKHAM HILLS NSW 2153

AUSTRALIA .

Phone / fax 02 9686 2325 - from outside Australia +(612) 9686 2325

Circle as appropriate

1. YES - I would like to order the BLOCK OF THE MONTH OFFER for A$30.00 per mont5h plus postage & handling. OR
2. YES - I would like to take advantage of the 10% discount offer and pay A$270.00 on one payment plus postage and handling. OR
3. YES – I would like to order the pattern only (available from March 2006) for A$88.00 plus postage & handling

METHOD OF PAYMENT

Circle as appropriate

Charge my - BANKCARD - MASTERCARD - AMERICAN EXPRESS CARD
or

PAID BY - MONEY ORDER - CHEQUE

(Money Order and Cheques are available to Australian Customers ONLY)

CARD NUMBER ___ __ __ __ / __ __ __ __ / __ __ __ __ / __ __ __ __

EXPIRY DATE __ __ / __ __

NAME ON CARD ___________________________________________________

Email address _______________________________________________________

Signature _________________________________

DELIVERY ADDRESS
Name; __________________________________________________

Address _________________________________________________ ___________________________ Post Code

Phone (____) ________________________