Kiwi Backyard Order Form

KIWI BACKYARD ORDER FORM
NAME:	.
EMAIL:	.
POSTAL ADDRESS:	.
DELIVERY ADDRESS:	.
PHONE NUMBER:	.
FAX NUMBER:	.

ORDER:	.

COST:	Product/Item cost	$
	Freight cost	$
	TOTAL	$

PAYMENT	Cheque payable to Kiwibackyard		.
	Credit Card		.
	Other		.
	Credit Card Details	VISA	.
		MASTERCARD	.

		Name on Card:		.
		Card Number:		.
		Expiry Date:		.

Thank you! MAIL: Kiwibackyard, "Sunninghill", Mill Rd, RD1, Takapau, Central Hawke's Bay or FAX 06 855 6583

By placing an order, we assume you have read and agreed to the Terms and Conditions. We will acknowledge your order by return e-mail, fax, phone or post.