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Budget Hampers
Gifts without compromise Ph: 1300 889 579

Client Name: ____________________________ ____________________________

Client Address: ____________________________ ____________________________


Description of Hamper


Subtotal: GST: Delivery: Total Amount of Order Delivery Date: ______________________________________________________ Delivery Address: ____________________________________________________ Delivery Contact Name & Phone: __________________________________________ Signature of Authorised Representative: ____________________________________ Method of Payment:
Credit Card Payments:

Direct Credit Visa

Credit Card Payment (contact office for details) Mastercard
(Sorry AMEX and Diners not accepted)

Name on Credit Card: ____________________________________________________________ Credit Card Number _____________________________________ Expiry ______________

Authorised Amount (Including GST & Delivery) $_________________________ Signature of Card Holder:__________________________________________________________

Please fax back to: 9882 9323 or email to:; alternatively you can post to Budget Hampers, Suite 1, 5 Rose Street, Hawthorn Vic 3123.