ORDER FORM



Name:
Address:
City:
State/Province:
Zip/Postal Code:

Country:
We should confirm your order:
Phone:
Full Email address:



ITEM # DESCRIPTION SIZE QTY ITEM
PRICE		 TOTAL
PRICE

Note: All prices in US Dollars.


Comments / Delivery instructions / etc:


Payment options:

Visa/Master-
Card # : Expiry:

Print & fax this form to 27 13 764 3302
Print & mail this form with cheque or money order to
SIMUNYE PROJECT
PO Box 494
Sabie
Mpumalanga
South Africa
1260
Telephone: 27 13 764 2641

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Last modified: February 14, 1997

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