| Name:
|
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| Company:
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| Postion:
|
|
| Address:
|
|
| Town: |
|
| Postal
Code: |
|
| Tel: |
|
| Fax: |
|
| Email: |
|
| |
| Items
to Purchase (Please Select) |
| |
| Title
1 |
|
| |
|
| Book,
Tape, CD, or Video: |
|
| |
|
| Title
2 |
|
| |
|
| Book,
Tape, CD, or Video: |
|
| |
|
| Title
3 |
|
| |
|
| Book,
Tape, CD, or Video: |
|
| |
|
| Title
4 |
|
| |
|
| Book,
Tape, CD, or Video: |
|
| |
| COUNTRY |
|
|
|
|
|
| South
Africa |
R45.00 |
R45.00 |
R375.00 |
R85 |
R375.00 |
| United
Kingdom |
£6.00 |
£6.00 |
£60.00
|
£10.00 |
£60.00
|
| United
States of America |
$10.00 |
$10.00 |
$100.00
|
$14.0 |
$100.00 |
|
| Postage
will be charged at R25.00 in South Africa or R60.00 ( £10.00
or $15.00) worldwide per item purchased. |
| PAYMENT
METHOD |
|
| |
| Total
|
|
| Postage |
|
| Total
Payment |
|
| Credit
Card Number: |
|
| Expiry
Date: |
|
| |
|
| CVC
Number: |
|
| (last
3 digits after the signature on the back of the card) |
| |
| Banking
Details |
|
| |
| Standard
Bank, Durban North Branch |
| Branch
Code: 04-28-26-05 |
| A/C
Name: Perception Business Books |
| A/C
No: 251180778 |
| |
| Cheques
Payable to: Perception Business Books |
| |
|
|
| |
