ADVENTURER MAPS ORDER FORM

Adventurer Maps ( Paoletti's Maps & Videos P/L )

15 Nirvana Close, Langwarrin South. 3911. Victoria. Australia.

Tel: (61) 03 9789 6985 Fax: (61) 03 9776 6798 Mobile: 0428 534 102

Email: info@adventurermaps.com.au Prop: Rudi Paoletti

Please provide the following order information: (You may also print this form off your browser and fax/post it)

First Name

Last Name

Contact Phone

E-mail

Do you want to join my Topic/Chats Group for general info, updates and trips?

YES

Please provide the following ordering information:

QTY
DESCRIPTION
PRICE QTY
DESCRIPTION
PRICE

SUBTOTAL $ DISCOUNT RATE IF APPLICABLE %

SUBTOTAL $ TOTAL $

BILLING

Credit Card Number

Expiry Date

Account Name

Credit Card:YES Direct Debit:YES Cheque:YES Money Order:YES

Direct Debit Details

Bank of Melbourne
BSB: 033 138

Account #: 136 980

Account Name: Paoletti's Maps

SHIPPING DETAILS

Street Address

City State

Postcode
Country

Additional Comments

QTY	DESCRIPTION	PRICE	QTY	DESCRIPTION	PRICE




SUBTOTAL $ DISCOUNT RATE IF APPLICABLE %
SUBTOTAL $ TOTAL $

BILLING
Credit Card Number
Expiry Date
Account Name

Credit Card:YES Direct Debit:YES Cheque:YES Money Order:YES

Direct Debit Details
Bank of Melbourne	BSB: 033 138	Account #: 136 980	Account Name: Paoletti's Maps

SHIPPING DETAILS
Street Address
City	State
Postcode	Country
Additional Comments