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Fax-back order form

Print out this form and fax to:
Burgewood Books
+61 3 9844 0664

Details of your order:

Name of book/s	Price
Cost of books	AUD$
Add  freight cost within Australia Up to AUD$35, add AUD$6.50 AUD$36-70, add AUD$8.50 AUD$71-125, add AUD$12.50	AUD$
OR add  freight cost overseas Up to AUD$35, add AUD$15.00 AUD$36-70, add AUD$28.00 AUD$71-125, add AUD$40.00	AUD$
Total due	AUD$

Please charge my credit card AUD$...............
Credit card type:...................................(Visa or Mastercard only)
Credit card number:.........................................................................
Expiry date:...................................
Credit card security number:...................(last three digits on signature strip)
Cardholder name:...................................................................................
Cardholder signature:.............................................................................

Name:...........................................................................................................................
Postal Address:............................................................................................................
.......................................................................................................................................
State:...................... .. Postal code:..................Country:..............................................

Phone no:.......................................................... 
Fax no:...............................................................
Email:.............................................................................................................