NB Either print this form fill it out or download it and complete then mail to the address below.

Please check the postage and handling conditions set out on the Salesroom page.

OFFICIAL ORDER FORM

TO: PARK ROAD MEDIA, 49 PARK ROAD, SURREY HILLS, 3127,

VICTORIA, AUSTRALIA.

OR: FAX TO 61 3 9888 9880

PLEASE FORWARD THE FOLLOWING ITEMS

PRINT CLEARLY WITH BALLPOINT

NAME :

ADDRESS :

TELEPHONE NUMBER :

E-MAIL ADDRESS :

Enclosed please find cheque or money order for AUS$

Or bill my credit card as follows:

CARD NUMBER: EXPIRY DATE: /

NAME AS ON CARD:

SIGNATURE:

CARD TYPE: VISA MASTERCARD BANKCARD

GUARANTEE: If not satisfied with goods – return them in original packing within 14 days and receive a full refund.