The Great Skeptic CD Order Form

Print this page, complete the details below and mail it to:

CD Sales
Australian Skeptics Inc
PO Box 268
Roseville NSW 2069
Australia

Your return mail address

Name ...........................................

Address ........................................

.................................................

Country ...............................

Postcode/Zipcode ......................

Phone (optional) .................... Email (optional) ...........................

Order Quantity

Quantity ......... x $55.00 ($AU) = TOTAL $.............

Payment Method

Cheque enclosed to 'Australian Skeptics Inc' 
or Credit Card  (complete the following details)

Name on card: .............................................

Card number: __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __

Card type: VISA  MasterCard  Bankcard

Expiry date: ____/____ Total Amount: $AU _________

Signature: ................................................