Toppix Limited – Doug Cole Photographer – Electronic Transfer Order Form

ELECTRONIC TRANSFER ORDER FORM

Prices/Sizes:

6x4 inch (10x15cm)		5x7 inch (13x18cm)		10x8 inch (20x25cm)		High res email
$6 each		$10 each		$20 each		$10 each

To order, please complete and submit this form online and then arrange payment by Electronic Funds transfer (direct credit). Payment can be deposited into account Toppix Ltd 03 0181 0210348 025 (Westpac Bank Milford). Please quote surname as a reference.

High resolution email images are sent soon after we receive your paid order.

Prints are mailed within a week. $2.50 postage

Citizenship Ceremony Date:

	Day	Month	Year

Name:

Address:

Phone:

Email:

Image No.
(from webpage)

Size

Quantity
( number not word)

Price
Per Photo

Total Price

$

$

$

$

$

$

$

$

$

$

Postage Option:

$

Grand Total to Pay:

$