Eco-Organics Automatic Deliveries Form

For weekly/fortnightly automatic deliveries copy/print this form, complete and return this form to Eco-Organics.

Name
Phone Number
Personal Shopping Code (if registered)

*N.B. New Customers Eco-Organics Registration Form must accompany this application.

Please send me:

$25 Sample

Fruit & Veges - Organic Eco Box

	$30 Basic	Fruit & Veges - Organic Eco Box
	$40 Extensive	Fruit & Veges - Organic Eco Box
	$55 Large	Fruit & Veges - Organic Eco Box
	Personalized Shopping Order attached & signed N.B. The value of this will vary according to current prices and availability.

For delivery every:

Authorization Signature:

Date: ____/____/______

N.B. We must be notified by midday the day before dispatch if you do not require a delivery for a specific dispatch date.

Please copy/print this form, complete and return via email, fax or post to:

Email: des@eco-organics.co.nz

Fax: (09) 411 8467

Post: Eco-Organics
          PO Box 546
          Kumeu
          Auckland