MIKE WALLER YACHT DESIGN - FAX / MAIL ORDER FORM
Complete this form then print, to obtain a fax or mail ready order. Or simply print the form and fill
it out by hand. Please do not forget to sign the form.
Fax To:  Online Sales   (07) 5499 3620    International +61 7 5499 3620
Mail To: PO Box 383, Morayfield, Qld, 4506, Australia
                                                                                 Please read How to Order before completing

PLEASE SELECT THE ITEM(S) YOU WISH TO PURCHASE:

Item Description (select from drop down list) $ea. Fwd.
Study Plans Aus $30.00 $
Study Plans Aus $30.00 $
Full Plans See Price List. $
TOTAL PURCHASE AMOUNT  $
PLEASE PROVIDE PAYMENT DETAILS
Card Type:

1. Visa
2. Master
3. Bank

 Card Details:

Card Number :  16 digits - no spaces
Expiry Date (MM/YY) /
Credit Card Validation Number *** 

*** (This is the last three digits of the number in the signature block  on the back of your card)  PLEASE NOTE THAT THIS NUMBER IS NOW REQUIRED BY CREDIT CARD AUTHORITIES FOR ALL TRANSACTIONS WHERE THE CARD IS NOT ACTUALLY PRESENT, i.e. Mail, Internet, Phone, Email. IF YOU HAVE NOT PROVIDED THIS NUMBER, WE ARE UNABLE TO PROCESS YOUR ORDER.

We regret we are unable to accept American Express or Diners cards
 
Full Name of Card Holder: 

It is expressly agreed that Mike Waller Yacht Design may debit the above account for the above specified amount.
Signature of Card Holder 
PLEASE PROVIDE SHIPPING (RECIPIENTS) DETAILS
Recipients Name:
Recipients Address:

Telephone Number:
Email Address:
  No data is retained by this form at any time. Your information is safe.