                     * * *  H A M    L O G   * * *
(v4.1)
                   * * *  O R D E R   F O R M  * * *

 TO:  Mr. Robin Gandevia,    Telephone: Intl: 61 2  (Local: 02)  9369 2218
      76 Carrington Rd.,     Fax:       Intl: 61 2  (Local: 02)  9369 3069
      WAVERLEY  NSW  2024    E-Mail:    rhg@bigpond.com
      AUSTRALIA

             * * *  ALL AMOUNTS IN AUSTRALIAN DOLLARS  * * *

 Please supply the following registered copies of HAM LOG:-

     ___  copies       @ $49.00       $ _____.___     (approx. $32.00 US)

 Please supply the following PRINTED copies of the manual:-

     ___  copies       @ $19.00       $ _____.___     (approx. $12.00 US)


   Shipping and Handling (AIR-MAIL):-
    Australia           FREE
    Overseas           @ $4.00        $ _____.___      (approx. $2.50 US)


                            TOTAL AUD $ _____.___

    Full Name: _________________________________________________________

    Address:   _________________________________________________________

    City:      ____________________  State: _______  Zip: ______________

    Country:   ____________________    CALL SIGN:  _____________________

    Phone:     ____________________    Fax:     ________________________

    E-Mail:    _________________________________________________________


 Payment Method:-

    MASTERCARD _____     VISA _____     Bankcard _____      Cheque _____

    Card Number:  ______________________________________________________

    Expiry Date:  ____________     Signature: 


    Please make cheques payable to:- ROBIN GANDEVIA (Australian $ Only)

 NOTES:
 - If ordering more than one copy, please supply the full user details
   for EACH copy.
 - Ordering from overseas is easy by fax or e-mail using a credit card.
 - If using e-mail, send credit card details in TWO separate e-mails.
 - Cheques may also be payable to: Dr. Hi Fi Pty Ltd.  (ACN 002 266 239)

                      YOUR ORDER WILL BE DESPATCHED BY AIR
