Sam Bear
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Mail Order Form

                             Phone 03 96632191 or email enquiries@sambear.com.au for any further assistance.
                             Fax to 03 96632187 or Mail to 225 Russell Street Melbourne 3000 Victoria Australia
 Order Date: (dd/mm/yy)
  Order From:
  Customer/Cardholder Name
  Your Home Address:
  Suburb, State, Postcode:
  Your Telephone Number:
  Your Fax Number:
  Your Email Address:
  Order Details:
Item Code Item Description - please include colour and size Price Quantity Total

 Sub Total

    

 Shipping

Please add $10.00 if the sub total is less than $120.00  

 *Total  Cost

    
  Payment By:
I authorise Sam Bear to charge my Visa MasterCard Amex
the *Total Cost for the Goods as described above including the Low Order Fee of $10.00
if the value of my order is less than $120.00  

Card Number:         CCV:        Exp: 

Name on Card:     Amount: 
 
Cardholder's Signature                                                    .
  Payment By:
Australia Post Money Order enclosed 


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