Name.........................................................................................................................................

Email address..........................................................................................................................

Address to ship goods to........................................................................................................

...................................................................................................................................................

...................................................................................................................................................

Please send me the following goods;

Catalogue number (if applicable)..........................................................................................

Brief description of goods (if other than book)....................................................................

Book only (author, title)...........................................................................................................

Listed price (in NZ$)................................

I wish to pay for the above goods (including P&P) by;

q    Credit card
q    Cheque (New Zealand only)

   Credit card details. Please tick one;

q    Visa
q    Master card

I authorize the billing of the above goods (including P&P) to my credit card. My card details are;

Cardholders name (as per card)...........................................................................................

Credit Card Number     ..../..../..../....//..../..../..../....//..../..../..../....//..../..../..../....

Expiry Date ..../....

If you are paying by credit card, please fax this form to us on +64 3 3287754.
Cheques (New Zealand only) can be sent to P.O.Box 240, Lyttelton, New Zealand.

Please tick

q    Post Airmail
q    Post Surface
q    Insurance required