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Back to Ordering |
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I ENCLOSE MY CHEQUE/MONEY ORDER FOR $ ...
PLEASE DEBIT MY VISA/MASTERCARD/BANKCARD No
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EXPIRY ./ ... . NAME ON CARD ..
SIGNED DATE / / |
q I WISH TO PAY BY PAYPAL
Please send me an invoice by email. |
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Please use this space to tell us about your pets: |
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PET 1 |
PET 2 |
PET 3 |
PET 4 |
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BREED |
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AGE |
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WEIGHT |
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SEX |
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WHERE DID YOU HEAR ABOUT OUR PET BEDS?
q Gardening Australia q Dogs Life Magazine q 101 Landscaping Ideas q Notebook Magazine q Inspirational Gardens q Card in my letterbox q Barka Parka Website q Other Website: Details _________________________________ q Recommendation: Details___________________________________________________________ q Other: Details ___________________________________________________________________ |
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ORDER FORM Print out this form and mail or fax to us |
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Barka Parka 1100 Stud Road Rowville, VIC AUSTRALIA 3178
Phone +61 3 9016 3394 |
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COLOUR SELECTION SINGLE or COMBINATION TOP, SIDE and Piping colours |
UNIT PRICE |
TOTAL
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Name .......................................................................
Address.....................................................................
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Home Ph ( )
Work Ph ( ) ..
Mobile ... |
Delivery Address (if different)
Contact Person ..
Address.........................................................
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............................... Postcode................
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Please make cheques and Money Orders payable to: Barka Parka |