Medicine Garden - Order Summary - Printer Friendly Version

Medicine Garden Australia Pty ltd. P.O Box 6432 Sth Lismore NSW Australia 2480

Ph: (02) 6622 2524 / Fax : (02) 6622 2500

International use (612) and not the (02) area code.

Customer Order Request

Name :
Address :
City :
State :
Country :
Postal Code/Zip Code :
Phone :
Fax :
Email :

Order Details

Item Code	Description		Price	Qty	Item Total



		Sub Total:			$0.00

Tick the shipping method you would like to use - For prices please check our website

Australia Post Express - Up to 500 grams	Australia Post Standard - Up to 500 grams
Australia Post Express - Up to 3kg	Australia Post Standard - Up to 3kg
International	Courier / Request Quote

Total cost of order is $0.00 + shipping cost of ___________ = ____________
(Please fill this in as a sign that you understand the terms & conditions of the order)

Payment Method
Cheque or Money Order payable to Medicine Garden Australia
Credit Card (Credit Card: Minimum $20 product purchase)

Credit Card Details

Card Type (MasterCard/ Visa/ Amex) :
Card Number :
Name (as it appears on the card) :
Expiry Date (Month/ Year) :
Issuing Organization :
Signature :

No credit card orders will be fulfilled without name of issuing bank or credit card issuer.