The Non Smokers' Movement of Australia Inc. - Order Form 2015

Please print this page now. Complete the details and mail to Box K860, Haymarket NSW 1240, or Fax to 02-9905-8787.

Dear NSMA,

I would like to order the following items:-

1. Red and White Large Anti-smoking Umbrellas.

Please send _____ @ $25 each.

2. Bound set of Update Newstetters, from 1 to the current issue.

Please send _____ sets @ $15 including postage.

Tick payment method:

Cheque attached ____ Credit card ____ Send Invoice ___
For Cheques:

Total payment enclosed is: $ ___________
For Cards only: Issued by: Bankcard / Visa / Mastercard

Expiry date: ____  / ____

Number: ________  ________  ________  ________

Signed: ____________________________________



Delivery Name: ___________________________________________________

Address: _______________________________________________________

________________________________________________________________

Suburb: ____________________________ State: ________Postcode: ________



Thank you for your support.
Note: We absorb GST input costs and therefore do not issue tax invoices.

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