Fax order form: Fax to 0027 12 361 0061

To order by fax, please print out this page, complete and fax to our offices.

Please note that all deliveries are done from London (UK) and that the US Dollar price includes delivery to any destination in the world.

Name and surname
Credit card type	VISA \| MASTERCARD \| AMEX \| DINERS (Circle the type)
Card number
CCV number (3 digit number on the back of your card on the signature strip)
Expiry date	Month (............) Year (............)
E-mail address
Telephone number
Full street or postal address (including State, Province and postal/ZIP code.)	line 1
	line 2
	line 3
Signature as on card: .....................................	Province/State:
	Postal / ZIP code:
	Country