LegBeds - Avoid that sinking feeling!

ORDER FORM

Name:
Postal Address:
Phone number:
E-mail address:
(i.e. me@here.com.au)
LegBeds Quantity:
(pack(s) of 5)		 (please just enter the number of LegBeds packs required)
Leg Ups Quantity:
(pack(s) of 4)		 (please just enter the number of Leg Ups packs required)
Singles (LegBeds):
Colour: Green Grey

Calculate Amount Owing:

Total Amount Payable:

$

Payment options:

Visa MasterCard BankCard
Cheque Money Order

Name on card:
Card number: - - -
Expiry date: /
Cardholders Signature:
Date:
Where did you find out about LegBeds/Leg Ups?:
Comments:

Please complete, print out this form, THEN SIGN THE CARDHOLDERS SIGNATURE, and fax to (08) 9330 5566
- or -
Mail to :

LegBeds
PO Box 500
Melville
WA 6956

 

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