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ORDER FORM - Christmas Cards


For further information/queries phone 0800 452 826, email info@glaucoma.org.nz

* First Name:
* Last Name:
* Address:
* Postcode:
* Telephone:
* Email:
Quantity: (12 cards per pack and envelopes)
I would like to purchase: Mixed Pack: $20.00 per pack
(includes 2 of each card design)
I would like to purchase: Single Design Pack: $20.00 per pack
A   B   C   D   E   F
Donation amount: $  
Total amount: (incl. GST, postage and handling)

* Payment options
Direct credit payment to ASB account
GLAUCOMA NEW ZEALAND
12-3013-0180964-00
Date of direct credit:
/ /
Credit Card
Cheque
Please print out this completed page and post together with your cheque to: Glaucoma NZ, Dept of Ophthalmology, Private Bag 92019, Auckland 1142.
Finally click submit button below to complete transaction.


* indicates mandatory field

For further information/queries phone 0800 452 826, email info@glaucoma.org.nz

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