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Name: |
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Personal Shopping Code: |
Please fill out the following only where specified details have changed.
| New Home Phone Number: | |
| New Work Phone Number: | |
| New Fax Number: | |
| New E-mail: | |
| New Postal Address: | |
| New Delivery Address: | |
| New Delivery Instructions: |
N.B. To ensure your delivery is made to the correct address make sure you notify us at least 48 hours before delivery if your order is going to a new address.
Credit Card Details
Type: Visa MasterCard (please circle)
| Card Number: |
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| Expiry Date: | |||||
| Issue Date: | |||||
| Card Holder's Name: | |||||
| Card Holder's Signature: |
I authorize Eco-Organics to charge my credit card with the total amount payable, including courier fee, for each and every order I place with Eco-Organics until and unless I notify Eco-Organics differently.
| Authorization Signature: | Date: |
Internet Banking & Cheque Customers copy/print, complete where applicable and return via email, fax or post.
Email: des@eco-organics.co.nz
Credit Card Customers please print this out and fax or post to:
Eco-Organics
PO Box 546
Kumeu
Auckland
Fax: (09) 411-8467