MAIL ORDER FORM FOR ROCKY LANE'S LATEST DVD

"POOL from Beginner to Champion"

 

I wish to order editions of the Rocky Lane Movie(s), entitled "POOL - From Beginner to Champion", which I trust you can Airmail to me within 10 working days please, from date of cleared payment. 

Here is my contact information:

Name:   *

Email Address:  *

Phone Number:  *

(Fill in either session A or B below, as appropriate)

A) CREDIT CARD ORDER:

Name on Credit Card: 

Credit Card Type (Visa, AMEX etc.):

Credit Card Number:

Expiry Date (mm/yyyy):

Total amount authorized to be debited against credit card for this order is USD .  Unit price is USD20.00.

B) OR; CHEQUE PAYMENT ORDER:

Please be informed that I have today mailed you a cheque / bank draft Number , in the amount of USD $20.00 (Twenty American Dollars), for each DVD ordered below, which includes postage and packaging, under order code (put any PIN code, you wish) , which I have written on the back of the cheque / bank draft, as an accurate reference. This is coming to you by airmail / courier (delete which) at your address, at "C/- Lane's view Heights, 18 Kilsyth Way, Howick, Auckland 2016, New Zealand", and I look forward to delivery within 10 working days, from the date of clearance of payment.  Cheques should be made payable to "The Melaaron Family Trust".

RECIPIENT'S NAME AND SHIPPING ADDRESS

Name

 *

Address

 *

* Mandatory Field