Scots Corner - Order Form

Scots Corner Order Form

TO:	SCOTS CORNER
	75 Fitzroy Avenue, Hamilton 3206, New Zealand
	Ph: +64 7 843 5264
	Email: scotscornernz@gmail.com

FROM: Name:

Street address:

Suburb:

City:

Country: Post code:

Phone:

Email address:

Payment method:

Name on card:

Card number:
Expiry date:

Signature:

Please complete the details above, then print this page and fill in your order.

Quantity

Description of Item (product id and name)
Clan Name

Unit Cost

TOTAL COST

Postage (to be added at cost):

Total:

Email or Phone with your order on 07 843 5264 or scotscornernz@gmail.com

Return to the previous page

FROM:	Name:
	Street address:
	Suburb:
	City:
	Country:	Post code:
	Phone:
	Email address:

	Payment method:
	Name on card:
	Card number:	Expiry date:
	Signature:

Quantity	Description of Item (product id and name) Clan Name	Unit Cost	TOTAL COST










Postage (to be added at cost):
Total: