KIWI BACKYARD ORDER FORM
NAME: .
EMAIL: .
POSTAL ADDRESS: .
DELIVERY ADDRESS: .
PHONE NUMBER: .
FAX NUMBER: .
ORDER: .
COST:
Product/Item cost
$
Freight cost
$
TOTAL
$
PAYMENT
Cheque payable to Kiwibackyard
.
Credit Card
.
Other
.
Credit Card Details VISA .
MASTERCARD .
Name on Card: .
Card Number: .
Expiry Date: .

Thank you!
MAIL: Kiwibackyard, "Sunninghill", Mill Rd, RD1, Takapau, Central Hawke's Bay
or
FAX 06 855 6583

By placing an order, we assume you have read and agreed to the Terms and Conditions.
We will acknowledge your order by return e-mail, fax, phone or post.