Please complete this form (within Australia only). Ensure that the credit card holder signs if payment is by credit card. Name: Address: Suburb: Daytime Phone: Fax: Email: Item Each Grain Of Rice (PAL VHS) Each Grain of Rice (PAL DVD) Each Grain of Rice (NTSC DVD) Freight (for 1 copy) Please add $3.00 freight for each additional copy Total Amount Payable Payment – Cheque or Money Order: Cheque/ Money Order for AU$ enclosed. Quantity Item Cost Each (incl. GST) AU$ 20.00 AU$ 35.00 AU$ 35.00 Total Cost AU$ AU$ AU$ AU$ 6.00 AU$ AU$ Post Code Mobile Phone No:
Please make payable to The Event Shop Pty Ltd and post to: The Event Shop PO BOX 3252, Rundle Mall, Adelaide, S.A. 5000. Payment - Credit Card: Please circle card type MasterCard Visa Bankcard Amex Diners Card Expiry Date:____/____ Card No:_________ _________ _________ _________ Name On Card: Signed: Your credit card will be debited by The Event Shop. Please fax this form to (08) 8223 6568 or post to The Event Shop, PO BOX 3252, Rundle Mall, Adelaide, S.A. 5000. Phone bookings and questions please call (08) 8225 8888. Your video/DVD will be forwarded to you by registered post, please allow 10-15 days for delivery. If payment is by cheque, we will allow cheque to clear and then your item(s) will be posted.
The Event Shop Pty Ltd Level 11 | 68 Grenfell Street Adelaide SA 5000 P +61 8 8225 8830 f +61 8 8223 6568 info@eventshop.com.au http://www.eventshop.com.au ABN: 85 088 077 123