ORDER FORM
Mail to:
Pétanque Boules Australia
45 Fiddaman Road
Emerald Beach  NSW 2456
( please Print the form below if you intend to mail your order in. Thank you. )

 
DATE: __ / __ /__
Mr /Mrs./Miss: _________________________________
ADDRESS: _____________________________ CITY: ___________
STATE: _____ POSTCODE:______
PHONE: _________________ FAX: _______________________
 

* Required Information

Date: / /
First Name: *
Surname: *
Address: *
City: *
State: *
Post Code: *
Phone: *
Fax:
   
Email: *
   
 
Qty Code Size Weight Striation  Your name or 9 Initial   Total
$
          $ $
          $ $
Please ADD $11.00 for delivery up to 3kg

or $25 for up to 5kg

 

Total

 $
 
 Net Bank to Pétanque Boules Australia
 B.C.U BSB 704328 A/C 196132
Please Address your Cheque or money Order to:
Pétanque Boules Australia
45 Fiddaman Road Emerald Beach  NSW 2456
Phone: 612 6656 2277
Signature:

 

 

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