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Bookstore BHS Publications |
PLEASE PRINT THIS PAGE AND FAX OR POST TO BALLARAT HERITAGE SERVICES Ballarat Heritage Services PO Box 2209 Ballarat Mail Centre 3354 Australia Phone 5331 7006 Fax 5331 6150 email ballaratheritage Order Form Please list all titles you wish to order : ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ All payments to be made in Australian Dollars Postage within Australia AUS $8.00 (email for advice on overseas postage) Name: ___________________________________________________________________ Address: ___________________________________________________________________ ___________________________________________________________________ Contact Phone Number:_____________________________ Payment by : Cheque _ Money Order _ Mastercard _ Bankcard _ Visa _ Amount: $_________________________________ Card No: | _ _ _ _ | _ _ _ _ | _ _ _ _ | _ _ _ _ | Expiry date: | _ _ | _ _ | Cardholder's Signature: ________________________________________________ DATE:_________________ |